Terms and Conditions of Participation in the Advantra Forever Fit Program Advantra Forever Fit is a wellness program presented to you by your Coventry health care plan in association with several carefully selected partners. Please be aware that certain aspects of this program are provided to you through websites operated by our partners. This Consent complements the Terms and Conditions of Use and Privacy Policy found on Coventry’s web site, as well as the web sites of its partners. You should familiarize yourself with those documents. Please review Coventry’s Terms and Conditions of Use and Privacy Policy. Please read this form carefully. It contains important terms about Advantra Forever Fit and the personally identifiable information you provide to Coventry and its partners when participating in the Forever Fit Program. On this consent, you will find an "I Agree" check box. If you check the "I Agree" check box, you will indicate your voluntary consent to participate in the Forever Fit Program. If you exit this window without checking the check box, you will not be enrolled. You are not obligated to participate in Advantra Forever Fit. However, if you are covered under an employer group policy, you should consult with your employer to determine if there are any benefits that you will not be eligible for as a result of not participating in this program. In the course of this program, Coventry and its partners collect information from you. Some of the information you submit may be personally identifiable information (for example, information such as your name, address, and information on your health). Coventry and its partners use that information to administer and provide Advantra Forever Fit to you. Coventry and its partners will maintain the confidentiality of your personally identifiable information and will only release personal information to a third party to: administer the Advantra Forever Fit Program, contact you for additional health plan services, conduct other health plan activities as permitted by law, or unless required to do so by applicable law or in response to valid legal process. If you are covered by an employer group policy, the plan sponsor of your employer group health plan may receive de-identified data reports regarding the health of its covered employees and also may receive certain limited identifiable information for purposes of administering its plan benefits. In addition, if your employer provides other health improvement programs through Coventry, such as smoking cessation counseling, disease management, pregnancy programs, Coventry or its partners may share that information with these other programs to bring you the most comprehensive program services possible. Similarly, as part of a disease management program, Coventry and its vendors also may share your information with a counselor to assist you in obtaining appropriate care. Neither Coventry nor its partners will share your personal information with third parties outside of the Advantra Forever Fit program. Coventry and its partners may use de-identified, aggregated data, for their own internal health research purposes. I AGREE