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Terms and Conditions of Medical Membership Program

1. MEMBERSHIP IS NOT AN INSURANCE POLICY:

  • The individual understands that they are purchasing a membership to an identified group in order to receive access to an affordable rate plan for medical services.
  • That membership rate plan is being offered by AWAAM Urgent Care clinics and covers services provided only at their clinic locations.
  • Member understands that this is NOT an insurance plan.
  • Members should not consider it to be an insurance plan or intend to use it as a substitute for an insurance plan.

2. DEFINITIONS:

  • Membership: For 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 member receives standard medical care as then provided in the normal course of business by AWAAM Urgent Care at a pre-established rate.
  • Member: The term which identifies the individual wishing to be provided with a membership to the AWAAM Urgent Care Medical Membership Program.
  • Minor: Will have the same meaning as that established by the State of Texas.
  • Dues: The monthly rate charged by AWAAM Urgent Care for inclusion in the Medical Membership Program.
  • Family Member: Immediate family members living in the home of the member (husband, wife, children, and stepchildren

3. MEMBERSHIP RESTRICTIONS:

  • A member’s privileges are subject to their having no outstanding amounts due to AWAAM Urgent Care.
  • Members must present a current picture ID to receive membership benefits.
  • Minors may not be seen by staff without a parent or a legal guardian is present or having signed a consent form on file, or as defined by state law.
  • This membership is non-transferable.

4. MEMBERSHIP RATES:

  • Members choosing the Monthly Membership Plan will be responsible for dues of $29 per month, which will include a $0 signup fee.
  • Family members to their Monthly Membership Plan will be responsible for dues of $79 per month

5. AUTOMATIC PAYMENTS:

  • Member understands their membership dues are paid by automatic withdraw/charge.
  • Member herein:
• Grants AWAAM Urgent Care permission to make such withdraws/charges.
• Agrees to provide AWAAM Urgent Care with accurate and valid account information to perform such withdraws/charges.
• Agrees to provide the identified entity (Bank, Savings Institution, etc.) from which these withdraw/charges are to be made with all notice and documentation that may be required.

6. TREATMENT INCLUDED IN MEMBERSHIP:

  • Only those healthcare services provided by AWAAM Urgent Care in the normal course of business subject to the sole discretion of AWAAM Urgent Care.
  • Treatment that is currently included within the membership:

Memberships

0% copay
Unlimited Clinic Visits
$ 29 – 1-family $ 79

Membership Plan includes:

Primary Care
Urgent care
Pediatrics
Annual Labs (Complete Blood Count, Chemistry and Lipid Profile, ekg one-time year)
30% off from any other blood work and ultrasound and X-ray

7. TREATMENT EXCLUDED FROM MEMBERSHIP:

Member understands AWAAM Urgent Care:

  • Is a provider of non-emergent episodic care.
  • Provides services within a certain scope of healthcare and there are services AWAAM Urgent Care does not provide.
  • The list below includes most, but possibly not all, of the services that are not included under the terms of their membership.

8. TERMINATION OF MEMBERSHIP:

  • Member fails to allow AWAAM Urgent Care the authority to withdraw/charge the monthly fees.
  • AWAAM Urgent Care has the right to cancel any memberships at any time for any reason. The effective date will be the same as the day of termination.
  • Falsification of identification or failure to pay will result in immediate termination of membership, assessment of utilization fee, full-price charges for any services rendered, and the full pursuit of the legal rights held by AWAAM Urgent Care.

9. CHANGES IN PERSONAL INFORMATION:

  • Members must inform AWAAM Urgent Care promptly of all changes to billing information.
  • If AWAAM Urgent Care is not able to receive payment of monthly dues because of changes in billing information not being provided, the account will be placed on hold until the past balance of Dues and correct billing information is provided to AWAAM Urgent Care. Accounts that are on hold will be terminated after 3 months of inactivity.

10. FORCE MAJEURE:

  • AWAAM Urgent Care 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 AWAAM
  • Urgent Care.

11. 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 Texas without regard to choice of law principles.

SUCCESSORS:

  • 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.

Signature

Date: _____________________________

AWAAM urgent care clinic

Date: _____________________________