This membership (“Agreement”) specifies the terms and conditions under which you the undersigned member (“Member”) may participate in CMC’s (‘Provider”) concierge Medicine Program (“Program”). This Agreement will become eRective either on the date the Program commences or the date of your signature of this Agreement, whichever is later (“Effective Date”).
1. Services Delivered. The Program’s monthly fee encompasses the following services (“Services”): Email/cell phone access, Improved Access-Available Same/Next Day appointments (unless office closed d/t holiday/vacation), Services/Procedures/Testing not covered by insurance and Referral Coordination.
2. Your Provider. You understand and acknowledge that your Provider may no longer be able to accept new members due to patient volume limits. Your Provider’s limited practice size enables your Provider to provide conveniences, such as same-day or next-day appointments that start on time, unhurried visits, availability via cell phone and enhanced coordination of specialist care at no additional charge to you.
3. Monthly Membership Fee. Each member over the age of 24 will pay a monthly fee (“Monthly Fee”) of $57.00 for an Individual Plan or $87.00 for a Family Plan. This fee for Adult members include unlimited office & tele/virtual visits with NO copay. Children of members under the age of 24 will be seen in-office for a per visit copay of $25.00. Patients will be notified in writing of any changes to fees. Membership also provides the opportunity for appointments outside of regular business hours (“afterhours”) by request through text, call, or email for a $25 copay. Home or Work House-Calls (“House-Calls”) are available by request through call, text, or email for a $75 copay.
4. Renewals and Termination. The Monthly Fee is for an annual/12-month term (“Term”). Failure to pay for the renewal of the Monthly Fee prior to the anniversary of the ERective Date shall result in termination of your membership in the Program. (For example, if the Effective Date is January 1, 2025, then you must renew it on or before December 31, 2025). You and your Provider my terminate this Agreement at any time upon 30 days written notice. If you or your Provider terminates this agreement for any reason prior to the end of your 12- month agreement, you will not be charged for the remainder of the 12-month period. Upon the receipt of the Agreement and the Monthly Membership Fee, CMC will have the option in its sole and absolute discretion, not to accept this Agreement and to return you payment to you. (e.g. due to limitations in practice size).
5. Medical Care Services Excluded from Annual Agreement. The Monthly Fee specified herin covers only the defined Services listed in Section 1, i.e. the membership benefits of this practice. Except for the Services listed in Section 1, you will be financially responsible for paying for all healthcare and medical care services received by you from your Provider and his or her staff. You do have the option to file a claim with your private insurer as “out of network”. This option excludes Medicare or Medigap.
6. Co-Payments/Deductibles. The Monthly Membership Fee does not affect any copayments or deductibles that you are required to pay for health care costs pursuant to the terms of your insurance coverage. You will continue to be financially responsible for any copayments, coinsurance or deductible amounts required by your insurer for test, procedures, or specialist’s services outside of this Agreement.
7. Entire Agreement. The undersigned agrees to the terms of this Agreement, all of which are expressed herin. There are no promises or representations except as set forth herein.
8. Notices. Any communication required or permitted to be sent under this Agreement shall be in writing and sent via U.S. mail to the addresses set forth in this Agreement. Any change in address shall be communicated in accordance with the provisions of this section.
9. Billing. Initial pro-rated payments are processed at the time of enrollment. Subsequent payments are charged monthly on the 1st of every month.
10. Governing Law. This Agreement shall be governed by and constructed in accordance with the laws of the State of Louisiana without regard to Louisiana’s choice of law provisions.