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Step 3 · Terms Agreement

CCA Terms of Service 2026

Review and acknowledge the terms for receiving assistance, including eligibility, approved vendors, medication, supply, and travel guidelines.

Community Cancer Association

Terms of Service (revised 5/2020)

General

  • The amount of assistance provided is subject to the availability of funds and monthly limitations for your necessary out-patient cancer needs. Limits are subject to change without notice. Currently, the allocated limit per month for year 1 & 2 on our service that we can spend is $400. For year 3 & 4, this limit we can spend is $200 per month. For year 5 and up (if necessary and qualifications are met) the monthly limit allotted is $100.
  • All items paid for by CCA must be for the personal use of the client and directly related to the treatment for, and the effects of, cancer. Medications or supplies for other conditions do not qualify for CCA assistance.
  • Client authorizes CCA to discuss medications and prescribed supplies with physicians, venders and other approved social service agencies.
  • Any misrepresentation of required information or misuse of the products and services provided may result in the suspension or termination of services.
  • Physical or verbal abuse of CCA employees or venders is cause for suspension or termination of service.

Eligibility

  • Eligibility is determined by diagnosis, residency, and financial need. Eligibility requirements are subject to change without notice.
  • Client must re-qualify annually.
  • Eligibility decisions are made at the discretion of the Executive Director and his/her decision is final.

Appointments

  • Due to small staff size, the CCA office is not manned at all times therefore appointments are strongly recommended.

Other Resources

• CCA will not pay for a product or service for which the patient is eligible for payment by another organization.

• If CCA identifies another organization which may provide payment for part or all of the items paid for by CCA, the client is expected to follow up on this information and apply for this assistance in a reasonable time. Failure to do so may result in CCA denying payment for the product or service that would have been covered.

• Denial of payment by the other organization due to the patient’s failure to cooperate or comply with its guidelines may also constitute grounds for CCA to deny payment.

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Venders

  • Patient is to use CCA approved venders for items to be paid for by CCA unless otherwise approved in advance.
  • CCA pays venders directly rather than reimbursing patient unless otherwise approved in advance.
  • Vender must get approval from CCA prior to releasing product to patient. There could be a delay in this so patient should make allowances.
  • CCA venders work in an agreed on manner with CCA and clients are also expected to comply with these terms.

Medications

  • When available, generic medications are required unless a brand is deemed medically necessary by the physician and approved by the CCA Executive Director.
  • Only prescriptions which are in conformity with any formulary established by CCA will be eligible for payment.

Supplies

  • CCA will only pay for a specified list of supplies related to the client’s cancer condition and treatment. CCA may require a physician’s prescription for supplies.

Cash for Travel

a. Requests for cash require at least 2 working days notice, proper documentation and are subject to the availability of funds.

b. All travel must be medically necessary. Personal preference does not qualify for CCA travel assistance.

Acknowledgment

Failure to abide by the terms of agreement may result in the suspension or termination of services.

I, the undersigned, have read the above and agree to abide by these terms of service as a condition for receiving assistance from Community Cancer Association.

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