On behalf of all of the members on this account, I understand and agree to the following (read and check all items indicating your acceptance):
A one-time $150 registration fee will, plus, a 3% Merchant Service Tax be included in my total initial charges.
I will be charged the monthly recurring subscription fee for services outlined in the membership I have chosen.
I may cancel at any time, but no refunds will be issued for paid fees.
I will pay a $25 fee per day for declined credit or debit card transactions.
My participation is continuous and by signing below I authorize recurring credit/debit card charges.
My participation is voluntary and subject to the terms and conditions of membership detailed at healthyhabitswellness.net
I understand this agreement does not include comprehensive health insurance coverage nor is it a contract of insurance.
Membership Terms & Conditions
Healthy Habits Wellness through its Physician(s) and Physician Assistant(s), collectively the “Physician(s)”, agrees to provide Patient with the Services described in this Agreement on the terms and conditions set forth in this Agreement.
- Patient. A patient is defined as those persons for whom the Physician(s) shall provide Services, and who are signatories to or listed on the Patient Registration Form that is incorporated by reference in this Agreement.
- Services. As used in this Agreement the term Services shall mean a package of services, both medical and non-medical, and certain amenities (collectively “Services”), offered by Healthy Habits, subject to change without further notice and further described at Healthyhabitswellness.net and the Patient Registration Form.
- Fees. In exchange for the services described herein, Patient agrees to pay Healthy Habits the amounts as set forth in the Patient Registration Form. These fees are payable upon execution of this Agreement and are in payment for the services provided to the Patient during the term of this Agreement. If this Agreement is canceled by Healthy Habits before the Agreement termination date, then Healthy Habits shall refund the Patient’s prorated share of the original payment remaining after deducting individual charges for services rendered to Patient up to cancellation. If the Patient cancels this Agreement, no refunds will be given. In any event, no refunds will be given for registration fees paid.
- Non-Participation in Insurance. The patient acknowledges that neither Healthy Habits nor the Physician(s) participates in any health insurance or HMO plans or panels and all have opted out of Medicare. Neither of the above makes any representations whatsoever that any fees paid under this Agreement are covered by any health insurance or other third-party payment plans applicable to the Patient. The Patient shall retain full and complete responsibility for any such determination. If the patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then the Patient will sign the opt-out agreement and incorporated by reference. This agreement acknowledges your understanding that the Physician has opted out of Medicare, and as a result, Medicare cannot be billed for any services performed for you by the Physician. You agree not to bill Medicare or attempt Medicare reimbursement for any such services. The patient shall renew and sign the opt-out agreement each year.
- Insurance or Other Medical Coverage. The patient acknowledges and understands 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). Healthy Habits will not cover hospital services, specialist visits, emergency room visits, surgeries, advanced radiology and imaging, worker’s compensation claims or any other services not personally provided by Healthy Habits or its Physicians. The patient acknowledges that Healthy Habits has advised that patients obtain or keep in full force such as health insurance policy (ies) or plans that will cover Patient for general healthcare costs. The patient acknowledge that this Agreement is not a contract that provides health insurance, and this Agreement is not intended to replace any existing or future health insurance or health plan coverage that the Patient may carry.
- Medical Services. As used in this Agreement, the term Medical Services shall mean those medical services that the Physician is permitted to perform under the laws of the State of Idaho and that are consistent with the training and experience of a family medicine physician, as the case may be. A list of current services offered is available at healthyhabitswellness.net and is subject to change without further notice.
- Availability. The Physician may, from time to time, due to vacations, sick days, and other similar situations, not be available to provide the services referred to above in this paragraph 6. During such times, Patient’s calls to the Physician, or to the Physician’s office, will be directed to a licensed medical provider who is “covering” for the Physician during his absence. Healthy Habits will make every effort to arrange for coverage but cannot guarantee such coverage.
- Pharmacy services. Healthy Habits has an on-site limited pharmacy. Patient is free to fill prescriptions at any pharmacy of their choice. If Patient elects to have the prescription filled at Healthy Habits, the cost of the medication will be charged to Patient and collected as any other fees are collected. Healthy Habits will not bill any insurance or other entity for medication costs.
- Third-Party Referrals and Preferred Rates. Physician may elect to coordinate with third party medical specialists to whom Patient is referred and may assist Patient in obtaining specialty care. Patient understands that fees paid under this Agreement do not include and do not cover specialists’ fees or fees due to any third-party medical professional other than the Healthy Habits Physician(s). In the event Healthy Habits is able to negotiate a preferred rate on behalf of Patient for third party services (including, but not limited to advanced imaging, specialist visits, laboratory work, hospitalizations and other third-party medical services), and such preferred rates require Healthy Habits to collect payment for services on behalf of the third party, such payments shall be paid by You to Healthy Habits in advance of Patient receiving such services. Any such payments on behalf of a Patient do not create any obligation on behalf of Healthy Habits other than to pay the third-party provider. Patient is under no obligation to use such referrals.
- Term; Termination. This Agreement will commence on the date first written above and will extend monthly thereafter. Notwithstanding the above, both Patient and Healthy Habits shall have the absolute and unconditional right to terminate the Agreement, without the showing of any cause for termination, upon giving 30 days’ prior written notice to the other party. Unless previously terminated as set forth above, at the expiration of the initial one-month term (and each succeeding monthly term,) the Agreement will automatically renew for successive monthly terms upon the payment of the monthly fee for the contract month. Alternatively, if the parties agree to provide and accept a membership on an annual basis, such termination and renewal policies shall adjust to an annual basis instead of a monthly basis.
- Electronic Communications. You acknowledge that communications with the Physician using e-mail, facsimile, video chat, texting instant messaging and cell phone (collectively, “Electronic Communications”) are not guaranteed to be secure or confidential methods of communications. As such, You expressly waive the Physician’s obligation to guarantee confidentiality with respect to correspondence using such means of communication. You acknowledge that all such communications may become a part of your medical records. Patient authorizes Healthy Habits, and its Physicians to communicate with Patient by Electronic Communications regarding Patient’s “protected health information” (PHI) (as that term is defined in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing regulations).
Patient further acknowledges that:
- Electronic Communications are not necessarily secure mediums for sending or receiving PHI and, there is always a possibility that a third party may gain access;
- Although Healthy Habits and the Physician will make all reasonable efforts to keep Electronic Communications confidential and secure, neither Healthy Habits nor the Physician can assure or guarantee the absolute confidentiality of Electronic Communications;
- In the discretion of the Physician(s), Electronic Communications may be made a part of Patient’s permanent medical record; and,
- Electronic Communications are not an appropriate means of communication regarding emergency or other time-sensitive issues or for inquiries regarding sensitive information. In the event of an emergency, or a situation in which Patient could reasonably expect to develop into an emergency, Patient shall call 911 or the nearest emergency room, and follow the directions of emergency personnel.
- If Patient does not receive a response to an Electronic Communication within one day, Patient must use another means of communication to contact the Physician(s). Neither Healthy Habits nor the Physician(s) will be liable to Patient for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to Patient 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, or failure to properly address e-mail or text messages,
- failure of the Clinic’s computers or computer network, or faulty telephone or cable data transmission,
- any interception of Electronic Communications by a third party; or
- your failure to comply with the guidelines regarding use of Electronic Communications as set forth in this paragraph.
- Change of Law. If there is a change of any law, regulation or rule, federal, state or local, that affects the Agreement including these Terms & Conditions, that are incorporated by reference in the Agreement, or 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 including these Terms & Conditions. If the parties are unable to reach an agreement concerning the modification of the Agreement within forty-five days after of date of 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 this 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 and 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 if Healthy Habits is therefore required to refund all or any portion of the monthly fees paid by Patient, Patient agrees to pay Healthy Habits an amount equal to the reasonable value of the Services actually rendered to Patient during the period of time for which the refunded fees were paid.
- Amendment. No amendment of this Agreement shall be binding on a party unless it is made in writing and signed by all the parties. Notwithstanding the foregoing, Healthy Habits may unilaterally amend this Agreement to the extent required by federal, state, or local law or regulation (“Applicable Law”) by sending You 30 days advance written notice of any such change. Any such changes are incorporated by reference into this Agreement without the need for signature by the parties and are effective as of the date established by Healthy Habits, except that Patient shall initial any such change at Healthy Habits request. 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 Patient may have under it, may not be assigned or transferred by Patient.
- Relationship of Parties. Patient and the Physician(s) intend and agree that the Physician(s), in performing his/her duties under this Agreement, is an independent contractor, as defined by the guidelines promulgated by the United States Internal Revenue Service and/or the United States Department of Labor, and the Physician(s) shall have exclusive control of his/her work and the manner in which it is performed.
- Legal Significance. Patient acknowledges that this Agreement is a legal document and creates certain rights and responsibilities. Patient also acknowledges having had a reasonable time to seek legal advice regarding the 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 Idaho and all disputes arising out of this Agreement shall be settled in the District Court of Ada County, Idaho.