Terms & Conditions
TERMS AND CONDITIONS OF MEMBERSHIP
CONVENIENT CARE PLUS IS A MEMBERSHIP IS NOT AN INSURANCE POLICY:
- Individual understands that they are purchasing a membership to an identified group in order to receive access to a discounted rate plan for medical services.
- The Convenient Care Plus network of clinics covers services provided only at their clinic locations and is offering a discounted rate plan.
- Member understands that this is NOT an insurance plan.
- Member should not consider it to be an insurance plan or use it as a substitute for an insurance plan.
- The plan makes payments directly to provider organizations for the medical services provided under the discount medical plan.
- Member is obligated to pay for all ancillary services.
- Members are not responsible for any costs associated with medical record transmission or duplication.
- Membership: For the purpose of these “Terms and Conditions” Membership is defined as an agreement entered into voluntarily by all parties. Terms of Membership provide that for an established monthly rate the Members receives standard medical care as then provided in the normal course of business by Convenient Care Plus clinics at a pre-established discount rate.
- Member: The term which identifies the individual who pays Dues and is provided with a Membership to the Convenient Care Plus “Convenient Care Plus” Membership Program.
- Minor: Will have the same meaning as established by the state of residence of the Member.
- Dues: The monthly rate charged by Convenient Care Plus for inclusion in the “Convenient Care Plus” Membership program.
- Family Member: Immediate dependent family members living in the home of the Member (husband, wife, children and stepchildren).
- Provider: Physician, Nurse Practitioner, and Physician Assistant.
3. MEMBERSHIP RESTRICTIONS
- A Member’s privileges are subject to having no outstanding amounts due to Convenient Care Plus.
- Some Member benefits may require that the Member present a current picture ID or membership card in order to receive Membership benefits.
- The initial Membership Term is for 12 months, and will renew for successive 12-month terms, unless terminated in accord with Paragraph 9.
- Dues will be charged and deducted on a prospective monthly basis.
- Minors may not be seen by staff without a parent or legal guardian being present or as allowed by law.
- Membership is non-transferable.
- Since the medical services included in Membership are “covered services,” persons with Medicare and Medicaid coverage are not eligible to be a Member (unless authorized by the State).
4. MEMBERSHIP PLANS/RATES
There are two plan types offered to Members.
There are three program levels offered to Members.
Member or Member’s employer will be responsible for Individual Monthly Dues. Primary Member understands that they are responsible for payment of any relevant Dues and any associated on-site visit fees, as well as those of all other Family Members covered under their Membership, unless dues are paid by employer. The latest rate information is available by contacting Convenient Care Plus at (855) 900-8701.
5. AUTOMATIC PAYMENTS
- For Members whose Dues are not paid by employer, those Members may pay their Membership Dues via automatic withdrawal / charge.
- In the event the Member chooses to have Membership Dues paid via automatic withdrawal/charge, Member herein:
o Grants Convenient Care Plus permission to make such withdrawals / charges.
o Agrees to provide Convenient Care Plus with accurate and valid account information to perform such withdrawals / charges.
o Agrees to provide the identified entity (Bank, Savings Institution, Credit or Debit Card, etc.) from which these withdrawals / charges are to be made with all notice and documentation that may be required.
o Member is not obligated to make any further payments under the plan, nor is the consumer entitled to any benefits under the plan for any period of time after the last month for which payment has been made.
6. PROVIDERS AND TREATMENT INCLUDED IN MEMBERSHIP
- Only those healthcare services then approved by Convenient Care Plus in the normal course of business subject to the sole discretion of Convenient Care Plus. A complete list of Convenient Care Plus Clinics can be found at www.convenientcareplus.com
- Treatment that is currently included within the Membership: Telemedicine Services, Urgent Care and Primary Care office visits at Convenient Care Plus Provider Clinics for colds/flu, bronchitis, pink eye, earaches, sinus infections, sore/strep throat, urinary/bladder infections, sprains, moderate complexity laboratory tests performed on site at Convenient Care Plus provider clinics (i.e. blood sugar, pulse oximetry, urinalysis, pregnancy test, strep screens), x-rays, splints, dressings, slings.
- Services may differ based upon clinics.
7. TREATMENT EXCLUDED FROM MEMBERSHIP
- Prescriptions (Some Member plans do include a generic prescription benefit).
- Providers will not prescribe DEA Controlled Substances, non-therapeutic drugs, contraceptives and other drugs which may be harmful because of their potential for abuse.
- Services that Convenient Care Plus will not provide at the time Member seeks medical care. Member understands that the list below is provided for example only and does not include all of the services that are excluded from coverage under the terms of their Membership. Excluded services include:
o Life threatening events such as gunshot wounds, heart attacks and serious infections, hospitalizations and treatment with other doctors or providers at another facility that are not Convenient Care Plus clinics, special diagnostic stuudies such as outside labs, ultrasounds, Doppler studies, mammograms, MRI’s, CAT scans, PET scans and other special x-rays that are not provided at Convenient Care Plus clinics, physical and occupational therapy, chronic pain management, X-ray over reads, psychiatric emergency management, outpatient pharmacy, work injuries and other workers compensation services and any emergency care that the attending physician or mid-level Provider believes should, in the best interest of the Member, be provided at another facility.
- The range of discounts for medical services provided under the plan will vary depending on the type of provider and medical service received
8. MEMBER USAGE
- Certain situations may require further medical attention including but not limited to: medical prescriptions, referral to a specialist, referral to a hospital or treatment that is not included in your membership. The cost of any charges associated with these additional services are NOT covered by this Membership. Any such costs are the sole responsibility of the Member.
- Convenient Care Plus reserves the right, in its sole discretion, to cancel Membership for inappropriate use of the urgent care or appointment based services, including, but not limited to request for services that are not then currently provided by Convenient Care Plus.
- The attending physician or mid-level Provider will determine the appropriateness of the Member’s visit.
- Members will have free access to providers as directed by Convenient Care Plus without waiting periods and notification periods.
9. TERMINATION OF MEMBERSHIP
- RIGHT OF CANCELLATION. Member has the right to cancel or return the plan within thirty days of its delivery and have all costs of the plan, excluding a nominal process fee refunded where allowed by law, if after examination of the plan the member is not satisfied with it for any reason
- Membership may be terminated by any of the following methods: o Member provides the Convenient Care Plus office with written notice of termination via letter, fax or email to the addresses or numbers provided at paragraph 21. Member benefits will end at the end of the month in which the notice of termination was received.
- Member fails to allow Convenient Care Plus the authority to withdraw / charge the monthly fee.
- Convenient Care Plus has the right to cancel Memberships at any time for any reason. If they choose to terminate the Member’s Membership, that termination will become effective immediately.
- Falsification of identification or failure to pay will result in immediate termination of Membership, assessment of utilization fee, full price charges for any service rendered, and the full pursuit of the legal rights held by Convenient Care Plus.
10. REACTIVATING A CANCELLED MEMBERSHIP
- A cancelled Member must pay $30 to reactivate within 12 months of cancellation in addition to the first and last months of membership dues.
- An individual may reactivate Membership 12 months after cancellation without a penalty.
- Convenient Care Plus reserves the right to deny the renewal privileges of any Membership terminated in accordance with Terms and Conditions of Membership.
11. CHANGES IN PERSONAL INFORMATION
- Members must inform Convenient Care Plus in a timely manner of all changes to billing information.
- If Convenient Care Plus is not able to receive payment of monthly dues because of changes in billing information not being provided, a $25.00 per month fee will be assessed on a monthly basis in addition to Dues until the Member provides Convenient Care Plus with their correct billing information or until their Membership is terminated.
- This additional monthly charge is subject to change without notice.
- The failure by Convenient Care Plus to exercise or enforce any of the Terms or Conditions of Membership is not to be deemed a waiver of Convenient Care Plus rights to enforce each and every term hereof. The failure by Convenient Care Plus to insist upon strict performance of any of the Terms or Conditions of Membership will not be deemed a waiver of any subsequent breach or default in the terms or provisions herein.
- The Membership may not be assigned or transferred.
15. LIMITATION OF ACTIONS
- Any legal action against Convenient Care Plus for a default of its obligations to the Member must be commenced within one (1) year from the date the default was, or should have been, discovered.
16. FORCE MAJEURE
- Convenient Care Plus is not liable for any delay or failure of performance caused by strikes, insurrection, war, fire, electrical failure, brown-outs, disruption of transmission lines, government acts or regulations, acts of third parties, or any cause not within the control of Convenient Care Plus.
17. GOVERNING LAW
- The validity, construction and interpretation of this Agreement and the rights and duties of the parties hereto will be governed by the laws of Nebraska without regard to choice of law principles.
- The exclusive venue for any litigation arising out of, or related to, these Terms and Conditions of Membership will be Douglas County, Nebraska.
19. ENTIRE AGREEMENT
- These Terms and Conditions of Membership constitute the entire agreement between the parties relating to the specific subject matter hereof. There are no terms, obligations, covenants, representatives, statements or conditions other than those contained herein. No variation or modification of these Terms and Conditions of Membership or waiver of any of the terms or conditions hereof, except that Convenient Care Plus may add or cease medical services it provides and included under the terms hereof, at its sole discretion will be deemed valid unless in writing and signed by both parties.
20. UNENFORCEABLE TERMS
- If any provision of these Terms and Conditions of Membership is held invalid, illegal, or unenforceable, these Terms and Conditions of Membership will be interpreted as if such provision, to the extent the same has been held invalid, illegal or unenforceable had never been contained herein.’
- These Terms and Conditions of Membership shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, successors, or executors.
- Any notice required or allowed to be given shall be addressed to the other party at the address set forth immediately following or to such other address as either party may instruct the other party in writing in accordance with this Section 22.
- CCP shall provide the specific information for the appropriate State Department of Insurance or regulator upon request.
Revised January 1, 2017