You must have your physician fill out the Verification of Medical Limitations/Restrictions form in its entirety. In order to be approved for cancellation for medical reasons, your doctor would need to state that your condition is on-going or permanent in nature. The condition or restriction must last beyond the term of the contract in order for it to be considered permanent. You will need to send the signed document back to NAC via CERTIFIED MAIL to:
NAC
PO BOX 6368
HARRISBURG PA 17112
The Verification of Medical Limitations/Restrictions form must be returned to our offices within 30 days of being signed by the member and the physician. Failure to remit the form within 30 days may result in a denied cancellation request and may require a new evaluation by your physician and the submission of an updated form. Please reference your account number in all correspondence. Please note that your account must be in good standing (paid current) in order for us to honor any cancellation requests.
Section 2: Consumer Disclosures
1. This AGREEMENT is cancelable should the member die or become physically unable to use the Center due to a permanent physical condition that arises following the date of this Agreement, as determined by NAC after review of all required documentation (a "Qualifying Disability"). Member or the member's estate seeking relief under this paragraph must provide proof of disability or death. A Verification of Disability Form shall be obtained from NAC upon request of member. A physical disability sufficient to warrant cancellation of the AGREEMENT by member shall be established once the member furnishes to NAC the Verification of Disability Form completed by a physician under appropriate state statutes to the extent the diagnosis or treatment of the Qualifying Disability is within the physician's scope of practice. Cancellations under this clause will only be accepted upon submission to NAC of the Verification of Disability or proof of death. More information on Verification of Disability may be obtained by contacting NAC at (800) 992-6024. All payments must be current prior to cancellation approval.