This DIRECT MEDICAL CARE AGREEMENT (the “Agreement”) is entered into by and between Apple Healthcare Group (the "Practice") and above-named Patient (the "Patient").
Enrollment. Patient hereby agrees to enroll as a member in the Practice's direct medical care agreement program ("Program") beginning on the Effective Date above. By being a member of this Program, Patient shall be entitled to receive the services and benefits described on Exhibit A ("Covered Services and fees"), attached hereto and made a part of this Agreement, and shall be subject to the conditions and limitations described therein. Enrollment in this Program includes only the Covered Services specifically described in Exhibit A. The Practice may add or discontinue Covered Services at any time, in its sole discretion. The Practice shall provide at least thirty (30) days' advance written notice upon any change to the Covered Services listed in Exhibit A.
Fees and Term of Agreement.
Patient agrees to pay fees for covered services and an associated subscription fee ("Subscription Fee") in accordance with the schedule attached hereto as Exhibit A, which is made a part of this Agreement ("Fee Schedule"). Patients may choose either a monthly or annual subscription option.
Regardless of the subscription type selected, Subscription Fees are not considered earned by the Practice until the end of each calendar month during the subscription term.
This Agreement shall remain in effect for the duration of the Patient’s active subscription and shall automatically renew at the end of each subscription period (monthly or annually, as applicable), unless either party terminates the Agreement in accordance with Section 5.
Non-Covered Services. Patient understands and acknowledges that Patient is responsible for any charges incurred for health care services performed outside the physical office space location of the Practice set forth above, including but not limited to emergency room visits, hospital and specialist care, and imaging and lab tests performed by third parties. Patient shall also be responsible for any charges incurred for health care services provided by the Practice but not listed on Exhibit A. The practice strongly encourages the patient to maintain health insurance during the term of this membership agreement to cover services that are not provided under this membership agreement. Patient should purchase health insurance to cover, at a minimum, unpredictable and catastrophic events.
Insurance. Patient acknowledges and understands that this agreement does not provide comprehensive health insurance coverage, is not a contract of insurance, and is not regulated by the insurance laws of Tennessee.
Insurance Claims. Patient acknowledges and understands that the Practice will not bill insurance companies on Patient's behalf for Covered Services provided to patient, and the Practice will not bill any health care plan of which the Patient may be a subscriber or beneficiary for Fees due and owing to the Practice under this Membership Agreement. Patient will not seek reimbursement from any insurance company or health care plan for reimbursement of Membership Fees.
Tax-Advantaged Medical Savings Accounts. As of the date of this Agreement, it is unlikely that the 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 unique, though, and Patient should consult with their health benefits adviser regarding whether Fees may be paid using funds contained in Patient's tax-advantaged savings account.
High Deductible Health Plans. Third party payers may not count the Fees incurred pursuant to this Agreement toward any deductible Patient may have under a high-deductible health plan. Patient should consult with their health benefits adviser regarding whether Fees may be counted toward the Patient's deductible under a high deductible health plan.
Termination of Agreement
Termination By Practice. The Practice may terminate this Agreement upon providing the patient with written notice of termination. Upon termination, the Practice shall cooperate in the transfer of Patient's medical records to the Patient's new provider, upon the Patient's written request.
Termination By Patient. Patient may terminate this Agreement at any time and for any reason, upon providing advance written notice to Practice. Such termination shall be effective on the last day of the then-current calendar month.
Return Of Unearned Fees. Upon termination of this Agreement, all unearned fees shall be returned to patient.
Medicare and TennCare Patients. Patients that are covered by Medicare and TennCare are not allowed by federal law to enter into a direct medical care agreement with a physician for services that are covered by Medicare or TennCare. If a service is not covered by Medicare or TennCare, that service may be provided pursuant to a direct medical care agreement.
Entire Agreement. This Agreement constitutes the entire understanding between the parties hereto relating to the matters herein contained and shall not be modified or amended except in writing signed by both parties hereto.
Change of Law. If there is a change of any law, regulation or rule, federal, state or local, which affects this Agreement, any terms or conditions incorporated by reference in this Agreement, the activities of the Practice under this 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 Agreement, then the Practice may, upon written notice, require the Patient to enter into good faith negotiations to renegotiate the terms of this Agreement. If the parties are unable to reach an agreement concerning the modification of this Agreement, the Practice may terminate this Agreement upon providing written notice to patient.
Governing Law. This Agreement and the rights and obligations of the Practice and Patient hereunder shall be construed and enforced pursuant to the laws of the State of Tennessee.
Assignment/Binding Effect. This Agreement shall be binding upon and shall insure to the benefit of the Practice and Patient and their respective successors, heirs and legal representatives. Neither this Agreement, nor any rights hereunder, may be assigned by the Patient without written consent of the practice.
THIS MEMBERSHIP AGREEMENT IS SUBJECT TO THE PROVISIONS OF THE HEALTH CARE EMPOWERMENT ACT (TENN. CODE ANN. §§ 63-1-501 ET SEQ.), WHICH REQUIRES THAT THE AGREEMENT CONTAIN THE FOLLOWING DISCLOSURES:
(i) The agreement does not constitute health insurance under the laws of this state;
(ii) An uninsured patient that enters into a direct primary care agreement may still be subject to tax penalties under the Patient Protection and Affordable Care Act, Public Law 111-148, for failing to obtain insurance;
(iii) Patients insured by health insurance plans that are compliant with the Patient Protection and Affordable Care Act already have coverage for certain preventative care benefits at no cost to the patient;
(iv) Payments made by a patient for services rendered under a direct care agreement may not count towards the patient's health insurance deductibles and maximum out-of-pocket expenses;
(v) A patient is encouraged to consult with the patient's health insurance plan, before entering into the agreement and receiving care; and
(vi) A direct primary care physician who breaches the agreement may be liable for damages and may be subject to discipline by the appropriate licensing board.
IN WITNESS WHEREOF, the parties have caused this Membership Agreement to be effective on the Effective Date first above written.
