Terms of Use
- Membership.
Subscriber hereby agrees to enroll as a member in the subscription based, Direct Care program. The Practice is a participating provider in the Direct Care program (“Membership Program”). The Subscriber will be participating in the Membership Program beginning on the Effective Date set forth above. By being a member of the program, Subscriber shall be eligible to receive certain medical services described on Exhibit A (“Covered Services”), attached hereto and made a part hereof, and shall be subject to the conditions and limitations described therein. Membership in the Practice’s Membership Program includes only the Covered Services specifically described in Exhibit A. The Practice may add or discontinue Covered Services at any time, as it may choose in its sole discretion. The Practice shall provide at least sixty (60) days’ advance written notice upon any change to the Covered Services listed in Exhibit A.
- Membership Fees.
Subscriber agrees to pay a subscription fee
(“Membership Fee”) in accordance with the schedule of
fees for the practice. Any fees or charges that are not
included in the Membership Fee (i.e. fees for
non-covered services) shall be due at the time of
service or may be pre-paid by the employer before time
of service. The practice offers a membership for single
membership, single + dependents or full family coverage.
- Non-Covered Services
Subscriber understands and acknowledges that Subscriber is responsible for any charges incurred for health care services performed outside of the physical office space location as set forth above, including, but not limited to, emergency room visits, hospital and specialist care, and imaging and lab tests performed by third parties. Subscriber shall also be responsible for any charges incurred for health care services provided by the Practice but not specifically described in Section 1 hereof.
THE PRACTICE STRONGLY ENCOURAGES THE SUBSCRIBER TO MAINTAIN HEALTH INSURANCE DURING THE TERM OF THIS MEMBERSHIP AGREEMENT TO COVER SERVICES THAT ARE NOT PROVIDED UNDER THIS MEMBERSHIP AGREEMENT. SUBSCRIBER SHOULD PURCHASE HEALTH INSURANCE TO COVER, AT MINIMUM, UNPREDICTABLE AND CATASTROPHIC EXPENSES
- Insurance
SUBSCRIBER ACKNOWLEDGES AND UNDERSTANDS THAT THIS MEMBERSHIP AGREEMENT OR MEMBERSHIP IN THE PRACTICE DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE, NOR IS IT A CONTRACT OF INSURANCE.
A. Insurance Claims. Subscriber acknowledges and understands that the Practice will not bill insurance carriers on Subscriber’s behalf for Covered Services provided to Subscriber and the Practice will not bill any health care plan of which the Subscriber may be a subscriber or beneficiary for Membership Fees due and owing to the Practice under this Membership Agreement. The Subscriber acknowledges that if services are performed at the Practice outside of what is covered, the Practice reserves the right to bill insurance carriers and the Subscriber may have a responsibility in the form of copay, deductible, coinsurance.
B. Tax-Advantaged Medical Savings Accounts. As of the date hereof, it is unlikely that the Membership Fees described in Section 2 constitute eligible medical expenses that are payable or reimbursable using a tax-advantaged savings account such as a health savings account (“HSA”), medical savings account (“MSA”), flexible spending arrangement (“FSA”), health reimbursement arrangement (“HRA”), or other health plans similar thereto (collectively referred to as a “tax-advantaged savings account”). Every health plan is uniquely different. Subscriber should consult with their health benefits advisor regarding whether Membership Fees may be paid using funds contained in Subscriber’s tax-advantaged savings account, as may be applicable. If a Subscriber chooses to self-pay for non-covered DPC services, the Subscriber may choose to pay for non-covered services using a Tax-Advantaged Medical Savings Account.
C. High Deductible Health Plans. Third party payers may not count the Membership/Subscription Fees incurred pursuant to this Membership Agreement toward any deductible Subscriber may have under a high deductible health plan. Subscriber should consult with their health benefits advisor regarding whether Membership Fees may be counted toward the Subscriber’s deductible under a high deductible health plan, as may be applicable.
D. Medicare. Subscriber acknowledges and understands that they are not eligible to participate in the Direct Care program if they are on Medicare. This means that Medicare cannot be billed for any services performed by the Practice. Subscriber agrees not to make any attempt to collect reimbursement from Medicare for any services provided by the Practice.
- Termination by Practice.
Termination of this Membership Agreement shall cause the termination of Subscriber’s membership in the Membership Program described herein.
A. Termination By Practice. The Practice may terminate this Membership/Subscription Agreement upon providing Subscriber advance written notice. Such termination shall be effective on the last day of then-current calendar month. Upon termination, the Practice shall cooperate in the transfer of Subscriber’s medical records to the Subscriber’s new primary care physician, upon the Subscriber’s written request and direction.
B. Termination by Subscriber. Subscriber acknowledges entry into this Membership Agreement is for a period of (30) days. Subscriber may terminate by providing advance written notice to the provider at the specific enrollment period. Subscriber must provide at least 48 hours notice prior to termination (business days). Such termination shall be effective on the last day of the then-current calendar month. Membership Fees shall not be pro-rated for any month. Monthly Membership Fees will continue to accrue until Subscriber’s written notice of termination is viewed by Practice at its office location set forth above in the online SAAS system. The subscriber can cancel in the directcaremarketplace.com system. If the subscriber fails to pay due to insufficient funds, the membership will be placed on an inactive status until the payment has been resolved.
- Indemnification.
Subscriber agrees to indemnify and to hold the Practice and its members, officers, directors, agents, and employees harmless from and against all demands, claims, actions or causes of action, assessments, losses, damages, liabilities, costs and expenses, including interest, penalties, attorney fees, etc. which are imposed upon or incurred by the Practice as a result of the Subscriber’s breach of any of Subscriber’s obligations under this membership agreement.
- Entire Agreement.
This Membership Agreement constitutes the entire understanding between the parties hereto relating to the matters herein contained and shall not be modified or amended except in a writing signed by both parties hereto.
- Waiver.
The waiver of either the Practice or Subscriber of a breach of any provisions of this Membership Agreement must be in writing and signed by the waiving party to be effective and shall not operate or be construed as a waiver of any subsequent breach by either the Practice or Subscriber.
- Change of Law.
If there is a change of any law, regulation or rule, federal, state or local, which affects this Membership Agreement, any terms or conditions incorporated by reference in this Membership Agreement, the activities of the Practice under this Membership Agreement, or any change in the judicial or administrative interpretation of any such law, regulation or rule, and the Practice reasonably believes in good faith that the change will have a substantial adverse effect on the Practice’s rights, obligations or operations associated with this Membership Agreement, then the Practice may, upon written notice, require the Subscriber to enter into good faith negotiations to renegotiate the terms of this Membership Agreement. If the parties are unable to reach an agreement concerning the modification of this Membership Agreement within ten (10) days after the effective date of change, then the Practice may immediately terminate this Membership Agreement upon providing written notice to Subscriber.
- Governing Law.
This Agreement and the rights and obligations of the Practice and Subscriber hereunder shall be construed and enforced pursuant to the laws of the State of the provider.
- Assignment/Binding Effect
This Membership Agreement shall be binding upon and shall inure to the benefit of both the Practice and Subscriber and their respective successors, heirs and legal representatives. Neither this Membership Agreement, nor any rights hereunder, may be assigned by the Subscriber without the written consent of the Practice.
IN WITNESS WHEREOF, the parties have caused this Membership Agreement to be effective on the Effective Date first above written.
SUBSCRIBER