This Membership Agreement (the “Agreement”) is made and entered into as of the effective date listed on your application, by and between Redirect Health, LLC, an Arizona Limited Liability Company, located at 13430 N Scottsdale Road, Suite 100, Scottsdale, Arizona, 85254 (“RDH”) and the individuals named on the membership application (the “Member” or “Members”).
THIS AGREEMENT IS NOT A HEALTH INSURANCE PLAN OR POLICY PURSUANT TO A.R.S. § 20-103, AND DOES NOT COVER SERVICES OR CARE GIVEN AT ANY OTHER FACILITY THAN THE PARTICIPATING CLINICS LISTED IN THIS AGREEMENT. MEMBER(S) ACKNOWEDGE AND UNDERSTAND THAT THIS MEMBERSHIP AGREEMENT OR ENROLLMENT IN IEVERYDAYCARE DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE, NOR IS THIS AGREEMENT A CONTRACT OF INSURANCE.
Member(s) hereby agree to enroll as a member in RDH’s iEverydayCare program (“Membership Program”), beginning on the effective date listed in the application. By being enrolled in the program, Patient shall be entitled to receive certain basic medical services described on Exhibit A (“Covered Services”), attached hereto and made part hereof, and shall be subject to the terms, conditions and limitations described herein.
Membership in the iEverydayCare program incudes only the Covered Services specifically described in Exhibit A and RDH may add or discontinue Covered Services at any time, as it may choose in its sole discretion, by modifying and posting a new Exhibit A on its iEverydayCare.com website. Anything not listed as a Covered Service shall be a non-covered (excluded) service.
2. Membership Fees
Member(s) agree to pay a monthly fee (“Membership Fee”) in accordance with the fee schedule set forth below (“Membership Fee Schedule”). The initial monthly fee may be pro-rated to your effective date. Membership fees are due on the 1st of the calendar month. Any fees or charges that are not included in the Membership Fee (charges for non-covered services), shall be due at the time of service.
(A) Nonpayment. If payment is not received by the 1st of the calendar month, RDH may, in its sole discretion, cancel this agreement or suspend benefits of membership under this agreement until payment is made current. In the event RDH elects to suspend services under this Agreement, Member(s) are not entitled to any pro-rata refund or account credits for any period during which benefits were suspended.
(B) Fee Schedule Changes. RDH may amend the Membership Fee Schedule set forth below at any time, as it may determine in its sole discretion, upon providing Member(s) at least 60 days’ advance written notice.
(C) Eligible Participants. Adult Members participating in the Agreement may add a spouse or legal dependents up to 26 years of age.
ANY INDIVIDUAL THAT IS A RECIPIENT OF MEDICARE, MEDICAID, AHCCCS, AN AHCCCS OR MEDICARE SPONSORED HEALTH PLAN, OR OTHER GOVERNMENT HEALTH CARE BENEFITS PROGRAM (SUCH AS ONE PROVIDED BY THE ARIZONA DEPARTMENT OF ECONOMIC SECURITY) ARE INELIGIBLE FOR PARTICIPATION IN IEVERYDAYCARE AND PROHIBITED FROM MEMBERSHIP.
By signing this Agreement, the Member(s) certifies that neither he/she, nor his/her spouse or dependents are enrolled in Medicare, Medicaid or other government-sponsored health benefit. The Member(s) further understand and acknowledge that if at any point he/she or his or her spouse or dependents enroll in Medicare, Medicaid, or other government-sponsored health benefit, this Agreement will be immediately terminated as of the date of enrollment, and refunds of prepaid monthly membership fees will be prorated to the date of termination. Notice of the intent of any Member(s) or his or her spouse or dependents to enroll in Medicare must be provided in writing to the Providers at least 60 days before the date of enrollment. RDH and its affiliates are generally prohibited from billing government health benefits programs for the services or supplies provided to the Member(s) under such programs, and Member(s) agree not to seek reimbursement from Medicare for any services or supplies provided under this Agreement.
FEE SCHEDULE - iEVERYDAYCARE
Individual Only $105
Individual and Spouse $200
Individual and Child(ren) $200
Individual, Spouse and Child(ren) $300
3. Non-Covered Services.
Member(s) understand and acknowledge that Member(s) are responsible for any charges incurred for health care services performed outside of the physical office space location as set forth below, including, but not limited to, emergency room visits, hospital and specialist care, and imaging and lab tests performed by third parties. Patient shall also be responsible for any charges incurred for health care services provided by RDH or an RDH-affiliated practice listed below, but not specifically described on Exhibit A.
RDH encourages the Patient to maintain major medical coverage during the term of this Membership Agreement to cover, at a minimum unpredictable and catastrophic expenses and other services that are not provided under this Membership Agreement.
4. Prior Authorization.
All services and appointments require pre-authorization. The Member must request authorization of services by calling RDH at 888-407-7928.
5. Participating Clinics.
Participating clinics at the date of this Agreement include those clinics listed on the Redirect Health website as a participating clinic.
6. Sedera Health
Sedera Health is an independent company from RDH. To the extent Member(s) have joined and become a member of Sedera Health in conjunction with enrollment into iEverydayCare, the terms and conditions of Sedera Health, as amended from time to time, and presently described in the Sedera Health Access Guidelines:
SEDERA HEALTH IS NOT AN INSURANCE COMPANY AND SEDERA’S MEDICAL COST SHARING MEMBERSHIP IS NOT ISSUED OR OFFERED BY AN INSURANCE COMPANY.
Member(s) agree to pay RDH monthly fees for participation in Sedera Health as set forth during Member(s) the enrollment. RDH may change the fees for Sedera Health by providing 30-days written notice to Member(s).
A. TERMINATION BY RDH. RDH may terminate this Membership Agreement upon providing Member(s) written notice and crediting the current month membership fee pro-rata for remaining days of the current calendar month. RDH reserves the right to refuse membership and RDH may terminate membership for any reason whatsoever, except on the basis of race, religion, sex or sexual-orientation.
B. TERMINATION BY MEMBER. Member(s) may terminate this Membership Agreement at any time and for any reason, upon providing advance written notice to RDH. Such termination shall be effective on the last day of the then-current calendar month. Membership Fees shall not be pro-rated for any terminal month. Monthly Membership Fees will continue to accrue until Member’s written notice of termination is received by RDH.
Any previous agreements, written or oral, between RDH, any of its employees, agents, brokers, o affiliates and the Member(s) are superseded by this Agreement. The terms of this Agreement are the final and complete expression of the agreement between the parties.
This Agreement shall be governed by the laws of the state of Arizona.
If any provision of this Agreement is held invalid or unenforceable by any court, the remaining provisions, to the extent consistent with the intent of the Providers and the Member(s), will not be affected, but will continue in full force and effect.
RDH may amend or modify his Agreement by posting a new version to its website and providing written notice (including by email) that modifications to the Agreement have been made to members. Such modifications shall become effective on the 1st day of the calendar month immediately following such notice.
The services provided under this Agreement are performed or directed by RDH-affiliated providers. The practitioners providing services under this Agreement are duly licensed to practice medicine and to otherwise provide such services within that practitioner’s scope of practice.
The following specific services and categories of service will be provided to the Member(s) under this agreement, as medically indicated (“Covered Services”):
1. Acute Care Services including care for or related to: coughs, colds, flu symptoms, sprains, sinus and ear infections, sore throat, fever, rashes, diarrhea, back pain, simple splinting of broken bones (not including manipulation of displaced or complex fractures), asthma, bronchitis, pneumonia, kidney and bladder infections, and other non-life threatening medical issues;
2. Performance of standard physicals including: school physicals, athletic physicals, scout physicals, adult physicals, mission physicals, annual physicals, and Department of Transportation physicals;
3. Provision of preventative care including: electrocardiograms (EKG), vision screening, and spirometry;
4. Minor Surgeries, wound care, minor laceration repair, wart destruction, simple lypoma removal;
5. Procedures, Tests, and Treatments including: in-house rapid strep and flu tests, nebulizer breathing treatment, abscess draining, foreign body removal, trigger point injections, routine labs, urinalysis, spinal manipulation & adjustments, and physical rehabilitation;
6. Provision of men’s and women’s specific health care including: well man and women screens, cancer prevention (including nutrition, physicals, and skin cancer treatment), pre-conception health, and peri-menopause and post-menopause health;
7. Pediatric care including: well child evaluations, acute care as listed above, and development evaluations;
8. Chronic therapy including care for or related to: diabetes, arthritis, acid reflux, high blood pressure, high cholesterol, cardiovascular disease, chronic fatigue, fibromyalgia, asthma, COPD, non-narcotic pain management, and low back pain;
9. Concierge and health system navigation services including: services available through Redirect Health including 24/7 Concierge CareLogisticsTM Support & Scheduling services (English & Spanish), Preemptive PCP Telehealth, Overpricing Protection, Healthcare Navigation, Physician to Physician Case Management (Hospital Cost Reduction, Discharge Management), Care Management – Chronic & Acute Disease (Includes predictive analytics and population health management.). Call 1-888-407-7928 for all questions, concierge scheduling, visit-by-phone and healthcare system navigation assistance.
10. Member-only discounted pricing (at least 40% discount off fee schedule) on other services may include specialist interventional pain management, durable medical supplies (splints and braces), x-ray, nerve testing and other diagnostic testing.
not specifically listed as a Covered Service shall be a non-covered service.
Any health care services not performed on or within the premises of Redirect
Health or Arrowhead Health Centers, including emergency room visits, hospital
stays, specialist care, imaging and labs, durable medical equipment (braces,
splints, etc.) and any care delivered by providers not affiliated with RDH is an
Additional Services NOT provided under this Agreement include, but are not limited to: major surgeries, procedures involving general or regional anesthesia, CT scans, MRI scans, echocardiograms, cardiac stress tests, pre-natal and obstetrical care, electroencephalograms, medications, chemotherapeutic treatments, oncology, radiation, any care given by a provider not listed as participating in this membership, any care in the sole determination of the provider that is best handled in the emergency room of a hospital, any procedure in the sole determination of the provider that falls outside of his or her area of training or expertise, or care rendered by specialists or specialty clinics.