ENROUTE HEALTH INDIVIDUAL TEXAS ONLINE URGENT CARE MEMBERSHIP AGREEMENT

(FOR INDIVIDUALS NOT ENROLLED IN MEDICARE)

 

 

This EnRoute Health, LLC Individual Texas Online Urgent Care Membership Agreement (the “Agreement”) is between the undersigned individual (“Member”) and EnRoute Health, LLC (“EnRoute Health”). By clicking to accept or agree to the Agreement when this option is made available to you, you accept and agree to be bound and abide by this Agreement.

  1. Term. The term of this Agreement will initially be for twelve months, beginning on the Effective Date (the “Initial Term”). The Membership Fees (as defined below) applicable for the Initial Term shall be due and payable upon execution of this Agreement. The Agreement shall automatically renew for successive terms of twelve month periods (each a “Subsequent Term” and together with the Initial Term, the “Term”) unless either party cancels the Agreement in writing within 30 days prior to the end of the Term.

  2. Limitations. This Agreement is NOT A HEALTH INSURANCE PLAN OR POLICY, and does not cover services or care given at any facility other than the participating clinics as shown below. Member further understands that EnRoute Health, LLC is NOT an insurance company. This Agreement includes only the specific services as outlined in Exhibit A, and does not include any major catastrophic medical care provided by emergency rooms, hospitals, services rendered by specialists or specialty clinics, or other entities not outlined specifically as a participating clinic.

  3. Eligible Participants. Member must be 18 years of age and older. A valid picture ID is required to enroll in a membership and will be required to verify identity before receiving membership services.

  4. Membership Fee Schedule.

       (a) At the date of this Agreement, monthly membership fees (the “Membership Fees”) for each Member participating in the services set              forth on Exhibit A (the “Services”) are as follows:

            $10 per month per month per each individual Member

       (b) Membership does not include Home Visits, In-house labs, medications or procedures.

           

  1. Payment. Membership Fees shall be paid by automatic yearly (12 calendar months) charges to Member’s credit card or debit card. Charges to Member’s credit card or debit card will occur every 12 months. Member shall update credit card or debit card information when necessary and in a timely manner, and will be responsible for any amounts owed to EnRoute Health regardless of whether the account or card is expired, cancelled, or otherwise not accepted for payment.

  2. Payment Information. This Agreement authorizes EnRoute Health, LLC to utilize PayPal to keep credit card or debit card information on file, and to charge Member’s applicable account for monthly fees without requiring EnRoute Health, LLC to obtain written authorization for each new charge.

  3. Appointment Scheduling. Member understands that the Member included in this Agreement will not be scheduled for a patient appointment unless the membership fees have been paid up through or beyond the date of the desired appointment.

  4. Termination/Cancellation; Cancellation Fee. Member understands that EnRoute Health, LLC may terminate this Agreement for any reason upon 30 days written notice. If Member terminates this agreement during the Term, Member shall pay a cancellation fee equal to the greater of (i) 10% of the total contract price or (ii) the retail cost of any visits and care that was incurred by Member during the membership period prior to such termination; provided, however, that Member may terminate this agreement without a cancellations fee if Member changes his or her personal residence to a location outside of the state of Texas. Member shall send any notice of termination to customerservice@enroutehealth.com. EnRoute Health, LLC may terminate this agreement immediately upon written notice if Member fails to make payment in accordance with EnRoute Health's LLC payment policies or if Member materially breaches this Agreement. If Member files a chargeback with a credit card company or bank against EnRoute Health, LLC, and EnRoute Health, LLC wins the dispute, then Member will be charged a $40 chargeback fee.

  5. Additional Charges. Member understands that there may be additional charges for equipment, laboratory, referral, or other services that are ordered through outside entities or EnRoute Health, LLC as a result of care given by a participating clinic or provider. This Agreement does not cover additional charges for such items. Only the services specifically outlined below in Exhibit A are covered by the Membership Fees. If a participating clinic or provider renders services beyond the scope of this Agreement, there will be added charges. The applicable Member must pay for these additional charges at the time of service. If these or any other additional charges are not paid at the time of service, Member agrees to allow EnRoute Health, LLC to charge Member for those amounts.

  6. No Additional Fees. Except for the membership fee paid by the Member, the Member shall not have any fees beyond the Membership Fee for all pre-authorized services listed in Exhibit A.

  7. Prohibition on Medicare Enrollment. Individuals also enrolled in Medicare are not eligible to participate in the services provided under this Agreement. EnRoute Health, LLC shall not bill Medicare for the services or supplies provided to the Member or his or her participating spouse or Dependents under this Agreement, and Member agrees not to seek reimbursement from Medicare for any services or supplies provided under this Agreement. If Member is eligible for Medicare, or, during the term of this Agreement Member becomes eligible for Medicare, then Member hereby agrees and acknowledges that Member shall promptly inform EnRoute Health, LLC of such event in writing.

  8. Right to Refuse Membership. EnRoute Health, LLC reserves the right to refuse membership to any person for any reason.

  9. Participating Clinics. Participating clinics at the date of this Agreement include those clinics listed in Exhibit B of this Agreement.

  10. Privacy Practices. Member hereby acknowledges receipt of EnRoute Health’s, LLC Notice of Privacy Practices set forth in Exhibit C attached hereto.

  11. Not an Insurance Plan. MEMBER AGREES AND ACKNOWLEDGES THAT THIS AGREEMENT IS NOT AN INSURANCE PLAN, AND, NOT A SUBSTITUTE FOR HEALTH INSURANCE OR OTHER HEALTH PLAN COVERAGE SUCH AS MEMBERSHIP IN AN HMO. Member understands that the waived Telemedicine visit fee and Membership Fees required under this contract MAY NOT apply towards any health insurance plan deductible. Member also understand that EnRoute Health, LLC makes no representations regarding the tax implications of membership in this agreement. Member and Member are encouraged to seek the advice of a competent tax professional for advice regarding any related tax issues.

  12. Claims Not Submitted to Insurance Plans. Member understands that EnRoute Health, LLC under this Agreement will not submit a claim for payment to any health insurer or any health insurer’s contractor or subcontractor for health care services provided to the Member(s) under this Agreement.

  13. Warranty Disclaimer. EXCEPT FOR THE EXPRESS WARRANTIES PROVIDED IN THIS AGREEMENT AND EXHIBITS HERETO, ENROUTE HEALTH MAKES NO ADDITIONAL REPRESENTATION OR WARRANTY OF ANY KIND WHETHER EXPRESS, IMPLIED (EITHER IN FACT OR BY OPERATION OF LAW), OR STATUTORY, AS TO ANY MATTER WHATSOEVER.

  14. Indemnification.
    (a) Member shall indemnify, hold harmless, and defend EnRoute Health LLC, its parent, affiliated and subsidiary companies, and the officers, members, directors, agents and employees of each (“EnRoute Health, LLC Indemnitees”) from and against any and all third party liabilities, claims, causes of action, suits, losses, damages, fines, judgments, settlements and expenses (including any and all reasonable outside attorneys’ fees and court costs) (collectively, “Claims”) which may be suffered, made or incurred by any of such EnRoute Health, LLC Indemnitees arising out of or relating to (a) Member’s breach of this Agreement, or (b) any grossly negligent or intentionally wrongful act of Member.

  15. Limitation of Liability. ENROUTE HEALTH, LLC WILL NOT BE LIABLE TO MEMBER FOR ANY PUNITIVE, INCIDENTAL, INDIRECT, SPECIAL, RELIANCE OR CONSEQUENTIAL DAMAGES, INCLUDING LOST BUSINESS, REVENUE, OR ANTICIPATED PROFITS, WHETHER BASED ON BREACH OF CONTRACT, TORT, OR OTHERWISE, AND WHETHER OR NOT ENROUTE HEALTH, LLC WAS ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. IN NO EVENT SHALL ENROUTE HEALTH’S AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT, WHETHER BASED UPON CONTRACT, TORT OR ANY OTHER LEGAL THEORY, EXCEED AN AMOUNT EQUAL TO AMOUNTS EARNED BY ENROUTE HEALTH, LLC WITHIN THE 12 MONTH PERIOD PRIOR TO THE EVENT GIVING RISE TO A CLAIM.

  16. Waiver of Trial By Jury. TO THE EXTENT PERMITTED BY APPLICABLE LAW, EACH PARTY HERETO HEREBY IRREVOCABLY WAIVES ALL RIGHT OF TRIAL BY JURY IN ANY ACTION, PROCEEDING OR COUNTER-CLAIM, ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT OR ANY MATTER ARISING HEREUNDER.

  17. Modifications; Waiver. This Agreement may not be modified except in a written document executed by Member and EnRoute Health, LLC. Any waiver of the provisions of this Agreement or of a party’s rights or remedies under this Agreement must be in writing to be effective. Failure, neglect, or delay by a party to enforce the provisions of this Agreement or its rights or remedies at any time, will not be construed as a waiver of the party’s rights under this Agreement and will not in any way affect the validity of the whole or any part of this Agreement or prejudice the party’s right to take subsequent action. Exercise or enforcement by either party of any right or remedy under this Agreement will not preclude the enforcement by the party of any other right or remedy under this Agreement or that the party is entitled by law to enforce.

  18. Force Majeure. Neither party will be in breach or default of this Agreement by reason of its delay or failure to meet any obligation hereunder due to any event, circumstance, or cause beyond its control such as but not limited to: governmental regulation, acts of nature or terrorism. The affected party will be excused from performance for as long as such force majeure event prevents such party from performing its obligations under this Agreement.

  19. Integration; Counterparts. Any previous agreements, written or oral, between EnRoute Health, LLC and Member with respect to the provision of care are merged into and superseded by this Agreement. The terms of this Agreement are the final and complete expression of the agreement between the parties. Notwithstanding the foregoing, the terms and conditions of any written agreement between the Member and EnRoute Health, LLC signed after the date hereof, including, without limitation, patient enrollment forms and acknowledgments, shall not be merged and superseded into this Agreement. This Agreement may be executed in counterparts, each of which will be deemed to be an original and together will constitute one and the same agreement. Counterparts may be delivered via facsimile, electronic mail (including pdf or any electronic signature complying with the U.S. federal ESIGN Act of 2000, e.g., www.docusign.com) or other transmission method and any counterpart so delivered shall be deemed to have been duly and validly delivered and be valid and effective for all purposes.

  20. Governing Law. This Agreement shall be governed by the laws of the state of Texas. The parties agree that any action arising out of or in connection with this Agreement will be heard in the federal and state courts in Bexar County in the State of Texas and each party hereby irrevocably consents to the exclusive jurisdiction and venue of these courts.

  21. Severability. If any provision of this Agreement is held invalid or unenforceable by any court, the remaining provisions, to the extent consistent with the intent of EnRoute Health, LLC and Member, will not be affected, but will continue in full force and effect.

  22. Notices; Communication. Any and all notices, requests, payments, demands and other communications, required or permitted hereunder shall be given to the respective parties in writing, either by personal delivery or by registered or certified mail, postage prepaid, return receipt requested, addressed to Member or EnRoute Health, LLC, as the case may be, at such address listed on the signature page hereto or as either party may from time to time designate by notice given as herein provided.

  23. Change of Law. If there is a change of law, regulation or rule, federal, state or local, which affects this Agreement, or affects the rights and responsibilities of either party under the Agreement, or there is any change in the judicial or administrative interpretation of any such law, regulation or rule, and either party reasonably believes in good faith that such change will have an adverse effect on that party’s rights and responsibilities associated with this Agreement, then that party may, upon written notice, require the other party 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 the Agreement hereto to within thirty (30) days after providing written notice to such party, then either party may immediately terminate the Agreement by notifying the other party in writing of the termination of this Agreement.

  24. Right to Counsel. Member acknowledges that this Agreement is a legal document and creates certain rights and responsibilities. Member also acknowledges having had adequate opportunity to confer with legal counsel regarding this Agreement and has either chosen not to confer with legal counsel or has done so and is satisfied with the provisions of this Agreement.

  25. Prevailing Party Legal Fees. The prevailing party shall be entitled to recover, in addition to any other amounts awarded, an amount for legal and other related costs and expenses, including attorneys’ fees, incurred thereby that is reasonable and equitable in relation to the award.

  26. English Language. This Agreement was negotiated and executed in the English language. In the event a conflict arises between the terms of this English version and a translation into any other language, the terms of this English version shall prevail. No translated version of this Agreement shall be binding on either party. The parties agree that this Agreement and all documents relating to this Agreement shall be written in the English language and no translation shall be binding on either party. Member acknowledges that it fully understands the contents and provisions of this Agreement, stated in the English language, and that it fully accepts this Agreement, and its effects and consequences.

This Agreement is not complete and binding unless the Member(s) also agrees to the provisions set forth in the Authorization for Automatic Payment attached here to as Exhibit C and any other patient related forms required by the entities providing care under this agreement. Those documents are herebyincorporated into this Agreement by this reference

 

 

EXHIBIT A

ENROUTE HEALTH SERVICES

The services provided under this Agreement are performed or directed by each of the medical practitioners listed under Exhibit B. The practitioners providing services under this Agreement are duly licensed to practice medicine and to otherwise provide such services within that practitioner’s scope of practice. The following specific services and categories of service will be provided to the Member and his or her participating spouse and Dependences under this agreement:

SERVICES INCLUDES IN THE  MEMBERSHIP

  • Urgent Care Telemedicine visits provided by a participating clinic listed in Exhibit B

  • Erectile Dysfunction Prescriptions (Patient must meet qualifications to receive a prescription. Membership does not guarantee a prescription.)

  • Chronic Medication Refills (Controlled substances, narcotics, or psychiatric medications do not qualify for medication refills under the membership agreement)

 

SERVICES NOT PROVIDED UNDER THIS AGREEMENT INCLUDE, BUT ARE NOT LIMITED TO: ANY HOME VISITS, IN-HOUSE LABS, MEDICATIONS, OR PROCEDURES and:

  • Outside labs, x-rays, CAT scans, MRIs, ultrasounds or other radiographic images.

  • Substance abuse or withdrawal

  • Allergy testing

  • Worker’s compensation

  • Pregnancy & pregnancy-related conditions, including infertility

  • Cancer or other chronic illnesses, such as heart disease or neurological diseases

  • Compound fractures (bone protrudes through skin)

  • Convulsions, seizures, or loss of consciousness

  • Deep knife wounds or gunshot wounds

  • Children under the age of 12 do not qualify for Telemedicine unless approved by a prescreen consult

  • Fever in a newborn less than 3 months old

  • Child fevers greater than 104 degrees

  • Heavy, uncontrollable bleeding

  • Moderate to severe burns

  • Poisoning

  • Serious head, neck, or back injuries

  • Severe abdominal pain

  • Indicators of cardiovascular disease (severe chest pain or difficulty breathing)

  • Indicators of stroke (e.g. loss of vision, sudden feeling numb, weakness, slurred speech, or confusion)

  • Severe mental illness, including suicidal or homicidal feelings

  • Chronic pain control

  • Mental Health 

  • Changes in mental status, such as confusion

  • Coughing or vomiting blood

  • Renal failure

  • Any care given by a provider not listed as participating in this membership, any care in the sole determination of the provider that is best handled in the emergency room of a hospital, any procedure in the sole determination of the provider that falls outside of his or her area of training or expertise, or care rendered by specialists or specialty clinics.

 

EXHIBIT B

PARTICIPATING MEDICAL CLINICS

Coastal Mobile Medical Group, PLLC dba EnRoute Health

 

EXHIBIT C

AUTHORIZATION FOR AUTOMATIC PAYMENT

I hereby authorize EnRoute Health, LLC and or their assign to charge the above referenced credit card or debit card automatically every month, and apply those charges to the membership fees required for participation in the direct primary care membership offered through the EnRoute Health, LLC and to any other charges I incur from services received through the participating clinics or providers that are not covered by the membership. I understand that I will remain responsible for recurring charges, additional late fees and any other applicable charges if the withdrawal to the bank account I have listed above is denied for insufficient funds or the account otherwise becomes unavailable.

I acknowledge that no entries may be made that violate the laws of the State of Texas, or the laws of the United States. I agree to indemnify the originating depository institution and any third party service providers involved in processing entries made hereunder against all claims, demands, losses, liability, or expense including attorney’s fees and costs that result directly or indirectly from a failure to abide by the terms of this Agreement, or a violation of the law.

I understand it is my responsibility to notify the Providers of changes to my address, phone number, email address and other billing or contact information. An inability to collect membership fees due to incorrect or outdated billing information will result in the termination of my membership, including family members signed up under the membership.

This authority is to remain in full force and effect until EnRoute Health, LLC have received written notification from the undersigned of its termination in such time and in such manner as to afford EnRoute Health, LLC a reasonable opportunity to act on it. Following termination of the authority granted hereby, Member shall make payments due to EnRoute Health, LLC at such time and in such manner as set forth in the Agreement.

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