Terms and conditions
Member Care Plan
24/7 Healthcare’s Member Care Plan is NOT health insurance. It is a supplement to insurance. If you have insurance already, we suggest you keep it but minimize your premiums to the lowest possible because you will be using our member care plan for "out-of-pocket" expenses instead of copays and deductibles, with regard to primary care and urgent care.
You will not be required to show us your insurance card for primary care or urgent care at our 24/7 Healthcare offices when your member plan is active.
Our online registration process takes less than 4 minutes to complete, simply enter your information, indicate a clinic locations (you can be seen at either) and submit your billing information.
Once finished, someone from our member services team will contact you within one business day of your completed registration. Note: if you are signing up as a part of a plan offered by your employer, please call your benefits office.
Authorization
Your monthly care fee covers the services described in the Member Care Plan Patient Services Guide. At times, however, your care may require durable medical supplies or third-party services that are not covered by your monthly care fee. To streamline your appointment check-out, please note that by providing the above billing information you authorize 24/7 Healthcare to automatically charge your card or draw on your bank account for any incidental items at the time of service. In all cases, incidental items are charged at or near our cost and will be discussed with you in advance.
By signing below, I hereby authorize 24/7 Healthcare to contact me using the information I have provided above. By signing below, I hereby authorize 24/7 Healthcare to initiate charges to my credit card, debit card or bank account for my periodic membership fee and any incidental fees that I incur or have incurred on my account since my last billing date. I understand that the transaction amount is the total of my care fee plus the care fees of any individuals on my account.
This authorization to perform periodic charges to my credit card, debit card or bank account will remain in full force and effect until 24/7 Healthcare has received written notification from me of its termination in such time and in such manner as to afford 24/7 Healthcare and my financial institution a reasonable opportunity to act on it.
I understand that my participation in 24/7 Healthcare is continuous and that, by signing below, I authorize recurring credit/debit card charges.
Patient Agreement & Disclosure Statement
I acknowledge and understand that I am voluntarily becoming a “Member Care Plan” patient and that this agreement is non-transferable.
I have reviewed the Member Care Plan Patient Services Guide and I have had the opportunity to ask questions and receive answers regarding its content.
I acknowledge and understand that this agreement does not provide comprehensive health insurance coverage nor is it a contract of insurance and that it provides only the health care services specifically described in the Member Care Plan Patient Services Guide.
I acknowledge and understand that I am responsible for any charges incurred for health care services performed outside of 24/7 Healthcare, including but not limited to emergency room, hospital and specialty services and that 24/7 Healthcare will not bill insurance carriers for any services provided by 24/7 Healthcare.
I acknowledge and understand that 24/7 Healthcare must maintain a record of my health information and must protect the privacy of my health information as per the terms of the Notice of Privacy Practices. I understand and acknowledge that this policy is available for my review at any time at upon request.
I acknowledge and agree to pay my monthly care fee on or before its due date. In the event that I am unable to pay my fee(s) on time, I understand that I will be blocked from membership if I am not able to resume payments within a 7-day grace period.
I acknowledge and understand that I may terminate this Patient Agreement at any time and for any or for no reason by providing written notice to 24/7 Healthcare. Monthly fees will continue to accrue until written termination notice is received. Any pre-paid monthly care fees will be prorated to the date 24/7 Healthcare has received my written termination and refunded to me within ten (10) business days.
In addition, I acknowledge and understand that 24/7 Healthcare may terminate this Patient Agreement by providing me written notice and any pre-paid monthly care fees will be prorated to the date of termination and refunded to me within ten (10) business days. 24/7 Healthcare will not terminate this Patient Agreement solely on the basis of health status.
I acknowledge and understand that 24/7 Healthcare may add or discontinue services or may increase my fee schedule at any time (but no more than once per year), and that I will be given, in writing, at least sixty (60) days notice of such fee schedule changes.
Rights & Responsibilities
I understand that I have the right to choose my personal health care clinician and to change my clinician at any time, for any reason. I understand that all reasonable efforts will be made to accommodate my request, but only if my new clinician’s patient panel is open to new patients.
I understand that I have the right to receive accurate and easily understood information about 24/7 Healthcare’s health care services, health care professionals and health care facilities. If I speak a language different from my clinician, have a physical or mental disability or do not understand something, I understand that 24/7 Healthcare will make its best effort to provide assistance so I can make informed health care decisions. If I require interpreter services beyond what can be provided by 24/7 Healthcare, professional interpreters may be provided at an additional cost to me.
In the event of membership termination, I understand that I must complete a written Service Cancellation Form. Any differences in payment between my billing date and the date of cancellation will be refunded to me via the payment method I have chosen for my monthly care fee. I understand that if my account is overdue, I am responsible for resolving the outstanding balance prior to my service cancellation.
I understand that I have the right to considerate, respectful, and nondiscriminatory care from my 24/7 Healthcare health care clinician (s). I also understand that I am responsible for communicating clearly and respectfully with my clinician. Should I become dissatisfied with my care or services, I agree to notify 24/7 Healthcare immediately so my concerns may be addressed in a timely manner.
I understand that I have the right to know all of my treatment options and to participate in my health care decisions. Parents, guardians, family members or other individuals whom I designate may represent me if I cannot make my own decisions.
I understand that I have the right to speak in confidence with my 24/7 Healthcare provider(s) and to have my health care information protected. I understand that 24/7 Healthcare will not disclose my information without my authorization or without a legal obligation to do so. I also understand that I have the right to review and receive a copy of my personal medical record and may request that my health care provider(s) amend my record if I feel it is inaccurate or incomplete by contacting the 24/7 Healthcare informatics department.
I understand that I have the right to a fair, fast and objective review of any complaint I have against my health care clinician(s) or any other staff, including complaints about wait times, operating hours, conduct of personnel, business practices, and adequacy of health care services and facilities. I agree to first bring any complaints to the attention of 24/7 Healthcare staff and to participate in the 24/7 Healthcare complaint and grievance process.
In order to receive the best possible care, I agree to be actively involved in my health care decisions and to disclose all relevant information to my 24/7 Healthcare health care clinician(s) so that they can help me achieve my health goals. I also agree to inform my 24/7 Healthcare health care clinician(s) of any health care services I receive outside of 24/7 Healthcare (such as emergency room, specialist, or hospital services).
I understand that I am responsible for not exposing myself or others to disease or danger. I understand that I can receive information from my 24/7 Healthcare health care clinician(s) about protecting the health and safety of myself and others.
By my signature below at the end of this form, I agree to become a 24/7 Healthcare Member Care Plan patient and I agree to the terms outlined in this Patient Agreement.
Coverage Reminder
Our Member Care Plan is NOT insurance. It is simply "prepaid direct medical care" and is not to be confused with an underwritten product.
However, Member Care Plans do qualify for Bronze Recognition under the Affordable Care Act (aka Obamacare), for businesses, and will be able to compete directly with insurance companies for employee enrollments.
We do still recommend (but not require) that you maintain a "catastrophic insurance plan" (i.e. low premium, high deductible) for problems that may require more than urgent care resources can address, such as a heart attack, stroke or getting hit by a truck!
Our Member Care Plan is primarily for non-emergency outpatient medical office matters, representing about 90% of medical encounters paid for with conventional insurance.
This enrollment form will lead to an activation of your coverage no sooner than 7 days, but no less than 30 days, after completing all the steps (Personal, Medical, Payment) correctly.
24/7 Healthcare’s Member Care Plan is NOT health insurance. It is a supplement to insurance. If you have insurance already, we suggest you keep it but minimize your premiums to the lowest possible because you will be using our member care plan for "out-of-pocket" expenses instead of copays and deductibles, with regard to primary care and urgent care.
You will not be required to show us your insurance card for primary care or urgent care at our 24/7 Healthcare offices when your member plan is active.
Our online registration process takes less than 4 minutes to complete, simply enter your information, indicate a clinic locations (you can be seen at either) and submit your billing information.
Once finished, someone from our member services team will contact you within one business day of your completed registration. Note: if you are signing up as a part of a plan offered by your employer, please call your benefits office.
Authorization
Your monthly care fee covers the services described in the Member Care Plan Patient Services Guide. At times, however, your care may require durable medical supplies or third-party services that are not covered by your monthly care fee. To streamline your appointment check-out, please note that by providing the above billing information you authorize 24/7 Healthcare to automatically charge your card or draw on your bank account for any incidental items at the time of service. In all cases, incidental items are charged at or near our cost and will be discussed with you in advance.
By signing below, I hereby authorize 24/7 Healthcare to contact me using the information I have provided above. By signing below, I hereby authorize 24/7 Healthcare to initiate charges to my credit card, debit card or bank account for my periodic membership fee and any incidental fees that I incur or have incurred on my account since my last billing date. I understand that the transaction amount is the total of my care fee plus the care fees of any individuals on my account.
This authorization to perform periodic charges to my credit card, debit card or bank account will remain in full force and effect until 24/7 Healthcare has received written notification from me of its termination in such time and in such manner as to afford 24/7 Healthcare and my financial institution a reasonable opportunity to act on it.
I understand that my participation in 24/7 Healthcare is continuous and that, by signing below, I authorize recurring credit/debit card charges.
Patient Agreement & Disclosure Statement
I acknowledge and understand that I am voluntarily becoming a “Member Care Plan” patient and that this agreement is non-transferable.
I have reviewed the Member Care Plan Patient Services Guide and I have had the opportunity to ask questions and receive answers regarding its content.
I acknowledge and understand that this agreement does not provide comprehensive health insurance coverage nor is it a contract of insurance and that it provides only the health care services specifically described in the Member Care Plan Patient Services Guide.
I acknowledge and understand that I am responsible for any charges incurred for health care services performed outside of 24/7 Healthcare, including but not limited to emergency room, hospital and specialty services and that 24/7 Healthcare will not bill insurance carriers for any services provided by 24/7 Healthcare.
I acknowledge and understand that 24/7 Healthcare must maintain a record of my health information and must protect the privacy of my health information as per the terms of the Notice of Privacy Practices. I understand and acknowledge that this policy is available for my review at any time at upon request.
I acknowledge and agree to pay my monthly care fee on or before its due date. In the event that I am unable to pay my fee(s) on time, I understand that I will be blocked from membership if I am not able to resume payments within a 7-day grace period.
I acknowledge and understand that I may terminate this Patient Agreement at any time and for any or for no reason by providing written notice to 24/7 Healthcare. Monthly fees will continue to accrue until written termination notice is received. Any pre-paid monthly care fees will be prorated to the date 24/7 Healthcare has received my written termination and refunded to me within ten (10) business days.
In addition, I acknowledge and understand that 24/7 Healthcare may terminate this Patient Agreement by providing me written notice and any pre-paid monthly care fees will be prorated to the date of termination and refunded to me within ten (10) business days. 24/7 Healthcare will not terminate this Patient Agreement solely on the basis of health status.
I acknowledge and understand that 24/7 Healthcare may add or discontinue services or may increase my fee schedule at any time (but no more than once per year), and that I will be given, in writing, at least sixty (60) days notice of such fee schedule changes.
Rights & Responsibilities
I understand that I have the right to choose my personal health care clinician and to change my clinician at any time, for any reason. I understand that all reasonable efforts will be made to accommodate my request, but only if my new clinician’s patient panel is open to new patients.
I understand that I have the right to receive accurate and easily understood information about 24/7 Healthcare’s health care services, health care professionals and health care facilities. If I speak a language different from my clinician, have a physical or mental disability or do not understand something, I understand that 24/7 Healthcare will make its best effort to provide assistance so I can make informed health care decisions. If I require interpreter services beyond what can be provided by 24/7 Healthcare, professional interpreters may be provided at an additional cost to me.
In the event of membership termination, I understand that I must complete a written Service Cancellation Form. Any differences in payment between my billing date and the date of cancellation will be refunded to me via the payment method I have chosen for my monthly care fee. I understand that if my account is overdue, I am responsible for resolving the outstanding balance prior to my service cancellation.
I understand that I have the right to considerate, respectful, and nondiscriminatory care from my 24/7 Healthcare health care clinician (s). I also understand that I am responsible for communicating clearly and respectfully with my clinician. Should I become dissatisfied with my care or services, I agree to notify 24/7 Healthcare immediately so my concerns may be addressed in a timely manner.
I understand that I have the right to know all of my treatment options and to participate in my health care decisions. Parents, guardians, family members or other individuals whom I designate may represent me if I cannot make my own decisions.
I understand that I have the right to speak in confidence with my 24/7 Healthcare provider(s) and to have my health care information protected. I understand that 24/7 Healthcare will not disclose my information without my authorization or without a legal obligation to do so. I also understand that I have the right to review and receive a copy of my personal medical record and may request that my health care provider(s) amend my record if I feel it is inaccurate or incomplete by contacting the 24/7 Healthcare informatics department.
I understand that I have the right to a fair, fast and objective review of any complaint I have against my health care clinician(s) or any other staff, including complaints about wait times, operating hours, conduct of personnel, business practices, and adequacy of health care services and facilities. I agree to first bring any complaints to the attention of 24/7 Healthcare staff and to participate in the 24/7 Healthcare complaint and grievance process.
In order to receive the best possible care, I agree to be actively involved in my health care decisions and to disclose all relevant information to my 24/7 Healthcare health care clinician(s) so that they can help me achieve my health goals. I also agree to inform my 24/7 Healthcare health care clinician(s) of any health care services I receive outside of 24/7 Healthcare (such as emergency room, specialist, or hospital services).
I understand that I am responsible for not exposing myself or others to disease or danger. I understand that I can receive information from my 24/7 Healthcare health care clinician(s) about protecting the health and safety of myself and others.
By my signature below at the end of this form, I agree to become a 24/7 Healthcare Member Care Plan patient and I agree to the terms outlined in this Patient Agreement.
Coverage Reminder
Our Member Care Plan is NOT insurance. It is simply "prepaid direct medical care" and is not to be confused with an underwritten product.
However, Member Care Plans do qualify for Bronze Recognition under the Affordable Care Act (aka Obamacare), for businesses, and will be able to compete directly with insurance companies for employee enrollments.
We do still recommend (but not require) that you maintain a "catastrophic insurance plan" (i.e. low premium, high deductible) for problems that may require more than urgent care resources can address, such as a heart attack, stroke or getting hit by a truck!
Our Member Care Plan is primarily for non-emergency outpatient medical office matters, representing about 90% of medical encounters paid for with conventional insurance.
This enrollment form will lead to an activation of your coverage no sooner than 7 days, but no less than 30 days, after completing all the steps (Personal, Medical, Payment) correctly.
