Insurance: You(Member) acknowledge that Today Clinic and it's providers may or may not be contracted with any health care plan of which you may be a subscriber. Today Clinic nor it's providers will bill any health care plan of which you may be a subscriber for membership or ancillary fees as long as your Today Clinic Select Health Plan remains in good standing. You also acknowledge as a condition of this agreement, that you will not seek reimbursement from any health care plan for fees paid to Today Clinic for the Select Health Plan.
Medicare: You acknowledges that if you are eligible for Medicare, or during the term of this agreement you become eligible for Medicare, you will be required to sign a yearly Medicare opt-out form.
Coverage: You acknowledge that the Today Clinic Select Health Plan does not constitute a health care plan. You also acknowledge that Today Clinic has advised you to obtain and maintain a health care plan for health care costs that may be incurred outside of this agreement. This Today Clinic Select Health Plan is not intended to replace any existing or future health care plans.
Fees: By signing this agreement you agree to sign up for a minimum of six months of the Today Clinic Select Health Plan. You acknowledge that if you decide to cancel your membership within this time period you are still responsible for all six months of membership fees. Any unpaid fees will be sent to collections with a collections fee of up to 30%. The membership fee is due monthly and is based on age as illustrated above. To avoid interruptions in your health plan you will be enrolled in an automatic bill-pay in which the monthly fee will be securely withdrawn from your bank account at the same time each month. If your payment card or address changes, please notify Today Clinic staff at (888) 861-1086 or email@example.com. Any ancillary fee is due at the time of service. Ancillary fees may apply to services or supplies/equipment not covered by this agreement. For a list of ancillary fees not covered by Today Clinic Select Health Plan, please ask one of our staff members. The membership fee is guaranteed for two years from the date of this agreement.
Terms: Today Clinic Select Health Plan will commence on the date the agreement is received with the first month's payment and the one-time account setup fee(if applicable). Today Clinic will have an absolute and unconditional right to terminate this agreement without cause upon 30 days written notice. After the initial six month membership term, the member will have an absolute and unconditional right to terminate this agreement without cause upon 30 days written notice. This agreement will automatically renew on a monthly basis upon receipt of the monthly membership fee beyond the initial six month time period.
Communications: You authorize Today Clinic to communicate with you or the parent/legal guardian if the member is a minor, about your personal health information in accordance with HIPPA regulations. At the discretion of Today Clinic, communications may become part of your permanent patient record. Today Clinic will make every reasonable effort to keep all communication with you confidential and
secure. In the event of an emergency, you shall call 911 or proceed to the nearest Emergency Department and follow the directions given by emergency personnel. You acknowledge that Today Clinic is not liable to you for any loss, injury, cost or expense resulting from or caused by a delay in responding to communication initiated by the member which include but are not limited to the following: technical failures due to internet service provider issue; electronic messaging software failure; power outages; email address errors; Today Clinic computer or network failures; faulty telephone cable or telephone data transmission; third party interception of communications.
Change of Law: If there is a change of any federal, state or local law, regulation, rule or the interpretation thereof that affects this agreement or the activities of either party in this agreement, and either party reasonably believes that the change will adversely affect the party's rights, operations or obligations associated with this agreement, then that party may either re-negotiate the terms of this agreement or terminate the agreement with written notice as specified above.
Severability: If any provision in this agreement is deemed legally invalid or unenforceable for any reason, the validity of the remaining agreement shall not be affected. That provision will be modified to the minimum extent necessary to make it consistent with applicable law in its modified form. That provision shall then become enforceable.
Reimbursement for services rendered: If for any reason, this agreement is deemed invalid and Today Clinic is required to refund a portion or all of the monthly fees paid by the member, the member agrees to pay Today Clinic a reasonable value for the services actually rendered to the member during that period of time in which the fee are required to be refunded.
Amendment: You acknowledge that Today Clinic may unilaterally amend this agreement to the extent required by local, state or federal law or regulations. Today Clinic agrees to send you thirty days advance written notice of such change. Moreover, if law requires provisions to be added to this agreement, such provisions shall be incorporated into this agreement and shall be deemed a part of this agreement as if they were part of the original agreement.
By signing below, I certify that I have read, understand and agree to the terms of this agreement. I, the undersigned, also give Today Clinic permission to to set up a monthly payment plan through joinit.org in which the monthly fee will be automatically charged to my account. I understand and agree that I am responsible for any ancillary fee not covered in this agreement and that the ancillary fees must be paid at the time of service. Furthermore, if the patient is a child between the ages of 0-17, I, the parent or legal guardian agree to the terms and conditions on behalf of my child.