ProPartners Healthcare, P.A.
Direct Primary Care Member Agreement
NOTICE: THIS MEDICAL RETAINER AGREEMENT DOES NOT CONSTITUTE INSURANCE, IS NOT A MEDICAL PLAN THAT PROVIDES HEALTH INSURANCE COVERAGE FOR PURPOSES OF THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT AND COVERS ONLY LIMITED, ROUTINE HEALTH CARE SERVICES AS DESIGNATED IN THE AGREEMENT.
This Agreement is entered into on the date specified in Appendix B of this Agreement by and between PROPARTNERS HEALTHCARE, P.A., a Kansas professional corporation, d.b.a. PROPARTNERSMD and PROPARTNERS FAMILY CARE (“PPHC”), located at 4501 College Blvd. Suite 300, Leawood, Kansas 66211 and Member named in Appendix B of this Agreement.
Through its physician employees, PPHC delivers health care services at the address set forth above. In exchange for fees, PPHC agrees to provide Member with the Services described within this Agreement, on the terms and conditions set forth in this Agreement.
- Member: As used in this agreement, the individual named in Appendix B of this Agreement.
- Member Services: As used in this Agreement, the package of health care and related services described in Member Services / Membership Fee (Appendix A), which is attached to this Agreement, and incorporated by reference.
- Membership Fee: As used in this Agreement, monthly payment made by Member to PPHC for Member Services provided to Member.
- Physician: As used in this agreement, a health care provider employed by PPHC to provide Member Services to Member.
- Ancillary Fees: As used in this Agreement, fees other than Membership Fee charged for ancillary services provided by PPHC. These may include items such as laboratory fees, prescription medications, dietary supplements, medical equipment and supplies, shipping and/or handling fees associated with these services, and any diagnostic or treatment services that are not explicitly described in Appendix A of this agreement.
- Health Care Plan (HCP): As used in this Agreement, any medical insurance or third party payment / reimbursement plan of which Member may be a subscriber or enrollee, designed to pay Member health care / medical expenses.
- Communications: As used in this Agreement, the various means available for communication between Member and PPHC. Options include voice (cell or land-line phone), digital (e-mail, facsimile, or text messaging), and/or virtual (video chat or other “Skype” like services).
- Insurance: Member acknowledges that PPHC and Physician may or may not be participating providers with any HCP of which Member may be a subscriber or enrollee. Neither PPHC, nor Physician, will bill HCP of which Member may be a subscriber or enrollee, for Membership Fee or any Ancillary Fees. Member further acknowledges that as a condition of entering into and maintaining this Agreement, Member will not seek reimbursement from any HCP for any fees paid to PPHC. If Member seeks reimbursement from any HCP for any fees due under the terms of this Agreement, this Agreement will terminate immediately.
- Medicare: MEMBER acknowledges and understands that PPHC and Physician have OPTED OUT OF MEDICARE. This means that Medicare cannot be billed for any services performed for Member by PPHC or Physician. Member agrees not to make any attempt to collect reimbursement from Medicare for any services provided by PPHC or Physician. If Member is eligible for Medicare, or during the term of this Agreement become eligible for Medicare, Member will be required to annually sign a Medicare opt-out agreement form.
- Medical Coverage: Member acknowledges that this Agreement is not an insurance plan, and is not a substitute for a HCP. This agreement only applies to services specified in this Agreement AND personally provided by PPHC and/or Physician. Member acknowledges that PPHC has advised Member to obtain or keep in full force a HCP to cover Member for health care costs incurred outside of this Agreement. Member acknowledges that this Agreement is not a contract that provides health insurance and this Agreement is not intended to replace any existing or future HCP.
- Fees: Membership Fee is due monthly. Membership Fee is based on age as illustrated in Appendix A. Ancillary Fees are due at the time of service. Membership Fee is guaranteed for one year from date of this Agreement.
- Terms: Unless otherwise specified, Agreement will commence on the date of this Agreement. Member or PPHC shall have the absolute and unconditional right to terminate this Agreement, without cause, upon 30 days prior written notice to the other party. Unless terminated as above, this Agreement will automatically renew on a monthly basis upon receipt of monthly Membership Fee, which is due during the month in which services will be rendered. Fee shall be paid by pre-authorized credit/debit card. There is also a one-time enrollment/account set-up fee paid upon receipt of this Agreement.
- Communications: Member authorizes PPHC to communicate with Member, or parent/legal guardian if Member is a minor, regarding Member’s Personal Healthcare Information (PHI), as defined in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and it’s implementing regulations. PPHC will make every reasonable effort to keep Communications confidential and secure. Member acknowledges that not all Communication options can be guaranteed to be confidential and secure. As such, Member expressly waives PPHC’s obligation to ensure confidentiality with respect to Communications. Member additionally acknowledges:
- If Member sends or receives Communications through an employer’s communication system, these Communications may become the property of the employer, and available for employer’s review.
- At the discretion of PPHC, Communications may be made a part of Member’s permanent medical record.
- Member understands and agrees that not all communication options may be an appropriate means of communication regarding emergent medical care, time-sensitive issues, or for inquiries regarding sensitive information.
- In the event of an emergency, or a situation in which the Member could reasonably expect to develop into an emergency, Member shall call 911, or proceed to the nearest hospital-based Emergency Department, and follow the directions of emergency personnel.
- If Member attempts to communicate with PPHC either digitally or virtually, and has not received a response within two business days, Member agrees to use one of the voice options of communication to contact PPHC. PPHC will not be liable to Member for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to Member as a result of technical failures, including, but not limited to: technical failures attributable to any internet service provider; power outages; failure of any electronic messaging software; failure to properly address e-mail messages; failure of PPHC computers or computer network; faulty telephone or cable data transmission; any interception of Communications by a third party; Member failure to comply with the guidelines set forth in this section.
- 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 the Agreement, the activities of either party under the Agreement, or any change in the judicial or administrative interpretation of any such law, regulation or rule, and either party reasonably believes in good faith that the change will have a substantial adverse effect on that party’s rights, obligations or operations associated with the Agreement, then that party may, upon written notice, require the other party to enter into good faith negotiations to renegotiate the terms of the Agreement. If the parties are unable to reach an agreement concerning the modification of the Agreement within forty-five days after the effective date of change, then either party may immediately terminate the Agreement by written notice to the other party.
- Severability: If for any reason any provision of this Agreement shall be deemed, by a court of competent jurisdiction, to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the Agreement shall not be affected, and that provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law in its modified form, and that provision shall then be enforceable.
- Reimbursement For Services Rendered: If this Agreement is held to be invalid for any reason, and PPHC is required to refund all or any portion of the monthly Fees paid by Member, Member agrees to pay PPHC an amount equal to the reasonable value of the Services actually rendered to Member during the period of time for which Fees are required to be refunded.
- Amendment: No amendment of this Agreement shall be binding on any party unless it is made in writing and signed by all the parties. Notwithstanding the foregoing, PPHC may unilaterally amend this Agreement to the extent required by federal, state, or local law or regulation (Applicable Law), by sending Member thirty days advance written notice of such change. Moreover, if Applicable Law requires this Agreement to contain provisions that are not expressly set forth in this Agreement, then, to the extent necessary, such provisions shall be incorporated by reference into this Agreement and shall be deemed a part of this Agreement as though they had been expressly set forth in this Agreement.
- Assignment: This Agreement, and any rights Member may have under it, may not be assigned or transferred by Member.
- Relationship of Parties: Member, PPHC, and Physician intend and agree that Physician, in performing his duties under this Agreement, is an employee of PPHC as defined by the guidelines promulgated by the United States Internal Revenue Service and/or the United States Department of Labor.
- Legal Significance: Member acknowledges that this Agreement is a legal document and creates certain rights and responsibilities. Member also acknowledges that Member has had a reasonable time to seek legal advice regarding this Agreement and has either chosen not to do so, or has done so and is satisfied with the terms and conditions of the Agreement.
- Miscellaneous: This Agreement shall be construed without regard to any presumptions or rules requiring construction against the party causing the instrument to be drafted. Captions in this Agreement are used for convenience only and shall not limit, broaden, or qualify the text.
- Entire Agreement: This Agreement contains the entire agreement between the parties and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement.
- Jurisdiction: This Agreement shall be governed and construed under the laws of the State of Kansas.
- Arbitration: All disputes arising out of this Agreement will be submitted to arbitration in the county in which the Physician is located, pursuant to the rules of the American Arbitration Association then in existence in the state in which the Physician is located. The decision in arbitration shall be conclusive and binding on the parties and may be reduced to judgment in any court of competent jurisdiction. The parties expressly waive their right to trial in any court.
- Service: All written notices are deemed served if sent by first class U.S. mail to the addresses recorded below.