I Understand that:

It is fully understood and agreed that (1) the Company has the right to accept or reject coverage; (2) no insurance coverage shall be in force until the Company receives the application, approves coverage and assigns the date on which coverage shall become effective; and (3) any premium or Application fee submitted herewith may be retained by the Company pending approval of coverage. If any coverage is approved, the Company will retain the premiums and the Application fee. If no coverage is approved, the Company will return any premium.

I understand and agree that after two years from the issue date only fraudulent misstatements in the application may be used to void the Policy or deny any claim for loss incurred or disability that starts after the two year period.

The undersigned authorize release to the Company or its representatives of: all past and future medical records and other information deemed necessary by the Company to underwrite this application and to process claims.

The undersigned hereby represents that the information on this application and any other information furnished by the undersigned is complete, true and correctly recorded and acknowledge that my coverage may be terminated or rescinded for fraud or deception in the use of the policy or for materially misrepresented information in the application.

By signing and dating this application, I verify that I am a United States citizen and a legal resident of South Carolina. This Plan is not available to non-U.S. citizens or non-residents of South Carolina.

I hereby attest that I understand that this coverage is not required to comply with federal requirements for health insurance and does not provide "minimum essential coverage" as definded under the Affordable Care Act.