SmartCross MedAccess Direct Plan
Primary and Urgent Care Medical Membership Service Agreement
This Primary and Urgent Care Medical Membership Service Agreement (“Agreement”) governs the relationship between SmartCross Healthcare, LLC, a Georgia corporation (“Provider”), the undersigned Member and any of the Member’s family members identified on the enrollment form (collectively, the “Member”) for the utilization of Services as defined in this Agreement.
THE MEMBER UNDERSTANDS AND ACKNOWLEDGES THE SERVICES DESCRIBED HEREUNDER DO NOT CONSTITUTE A HEALTH INSURANCE PLAN OR PROGRAM. THE PROVIDER STRONGLY RECOMMENDS THAT THE MEMBER ACQUIRE HEALTH INSURANCE FOR MEDICAL NEEDS NOT DESCRIBED AS PART OF THE SERVICES OF THIS AGREEMENT OR BY MEDICAL PROFESSIONALS OUTSIDE THE GEORGRAPHIC LOCATION OF THE PROVIDER.
The Provider retains complete and sole discretion to determine which Services are medically appropriate. Should the Provider determine, in its sole discretion, that a Member's medical condition warrants treatment by a specialist, an emergency department, or if the Provider cannot adequately treat a Member's condition, then the Provider will not provide treatment. However, if a reasonable amount of time is spent with the Member, the Provider will charge, at its discretion, the appropriate Usage Fee. The Member is solely responsible for the cost of any required medical transportation for the Member.
Section 1. Services and Payment
Upon the Provider’s acceptance of the Member’s Enrollment Form and the Member’s payment of the appropriate fees specified in the Enrollment Form, the Member will receive a Member identification card and will be eligible to receive any of the Services, which are deemed to be medically appropriate. The Member may utilize any location wholly owned and operated by the Provider to receive the Services and will also have access to any future discounts offered through affiliate or partner healthcare service providers.
The Services provided are at the discretion of Provider, but are similar to those provided by a primary care provision, and may change from time to time at the Providers sole discretion. The Provider agrees to provide the Member with any of the Services deemed to be medically appropriate, provided the Member is not in arrears to the Provider and is in compliance with the other requirements of this Agreement. Should the Services provided change, the Member will be notified of any such changes in writing before they occur.
All required payments under this Agreement are to be paid to the Provider on the first (1st) day of the month prior to the month in which the Member wishes to receive care. Payment must be made prior to the receipt of any Services.
A default occurs when any payment due under this Agreement is more than ten (10) days late. Should any monthly payment become more than ten (10) days late, Member will incur a late fee of $20. Should Member default in payment, Member agrees to pay all reasonable costs of collection, including but not limited to a reasonable attorney's fee as might be allowed by law, whether the account shall be referred to a collection agency or an attorney. An additional service fee will be charged for any check, draft, credit card, or order returned for insufficient funds or for any other reason. If the Member is paying monthly dues by Electronic Funds Transfer (EFT), Provider reserves the right to draft via EFT all amounts owed by the Member including any and all late fees and service fees subject to appropriate State and Federal Law.
Each of the Services will require the Member to pay an additional fee to the Provider each time the Member visits the Provider as described in the table below:
|Type of Visit
||Silver Plan - Usage Fee
||Gold Plan - Usage Fee
||Oglethorpe Health Plan
** SILVER AND GOLD PLANS PERTAIN TO SMARTCROSS MEMBERSHIP. NOT APPLICABLE FOR OGLETHOPE STUDENTS **
Urgent Care visits will be defined as those visits that are episodic in nature or walk-in and accordingly did not have a scheduled appointment time. Primary Care/Follow-Up visits are more preventative and coordinated in nature and will have an associated appointment time. The Services include an office visit with a licensed medical provider for the diagnosis and treatment of basic health care needs in addition to any in-house labs and/or x-rays performed.
Should the Usage Fee Schedule change, the Member will be notified of any such changes in writing before they occur. Members enrolled in the month-to-month program will adhere to the updated Usage Fee Schedule the first month following the notification of such changes. Members enrolled in pre-paid programs will adhere to the updated Usage Fee Schedule at the time of membership renewal.
This Agreement is non-transferable.
Section 2. Commencement
This Agreement will become effective following the payment of the appropriate membership fee.
Section 3. Membership Cancellation
A Member may cancel this Agreement under the procedure described below:
- Month-to-Month Cancellation Policy. A Member may cancel the month-to-month Agreement at any time by providing thirty (30) days written notice to the Provider; provided, however, Member is in full compliance with this Agreement and is not in arrears to Provider. The cancellation, applicable to the Member and Member's family signed under this Agreement, shall become effective upon the last day of the month following the thirty (30) days from the written notice.
- Pre-Paid Cancellation Policy. Pre-paid memberships may also be cancelled at any time by providing sixty (60) days written notice to the Provider; provided, however, Member is in full compliance with this Agreement and is not in arrears to Provider. The cancellation, applicable to the Member and Member's family signed under this Agreement, shall become effective upon the last day of the month following the sixty (60) days from the written notice.
In the event of the death of the Member or any family member, and upon receipt by the Provider of a certified copy of the Member's death certificate, the Provider will refund to the decedent's estate (or its representative), and within thirty (30) calendar days of the Provider's receipt of the death certificate, a portion of the fee equal to the number of calendar days remaining in the same month following the death divided by the total number of calendar days in the same month of the death for the decedent.
Section 4. Change in Membership Level
All Members are eligible to upgrade/downgrade their Membership level (ie. Silver, Gold, Platinum) at any time during their enrollment period.
Should a Member elect to upgrade their Membership level, the Member will be required to provide thirty (30) days notice to active the upgrade and will also be required to pay any difference in pre-paid Membership fees and Month-to-Month fees moving forward.
Should a Member elect to downgrade their Membership level, the Member will be required to provide thirty (30) days notice to activate the downgrade and will be entitled to a credit of any pre-paid differences.
Section 5. Standards of Conduct
All Members are obligated to follow these standards of conduct while receiving Services under this Agreement:
- Each Member is responsible for their family members' conduct while receiving the Services.
- Each Member is required to register at the Provider's reception desk and present the Member identification card to the Provider at the time of check-in to receive the Usage Fee rates.
- Each Member shall, in the event of injury or illness requiring emergency or specialized treatment, go directly and immediately to a hospital or emergency room.
- Each Member shall conduct themselves in a quiet and well-mannered fashion while visiting the Provider so as not to cause any disturbance, which would interfere with the use and enjoyment of the Provider's facility by others.
- No Member shall use profane, loud or slanderous language, harass, molest, badger or solicit other Members or the staff and guests of the Provider, for any reason.
- Other than a health care-related matter requiring immediate action by a Provider, any complaint, protest or greivance of any nature must be made directly to the (a) manager of the Provider or (b) Member liason, in private.
The Provider has the right to add to, delete, or change any of these standards with prior, written notice to the Member.
The Provider retains the right to cancel this Agreement if the Provider determines that a Member (or a family member) is (a) ineligible for the Services; or, (b) willfully failing or refusing to abide by any of these standards of conduct. Should the Provider terminate this Agreement, the Member will be refunded the appropriate pro-rated portion of their pre-paid membership fees.
Section 6. Miscellaneous
In the event a Member has a life-threatening emergency while visiting the Provider, the Member hereby gives consent to the Provider to make arrangements for the Member's emergency transportation to an appropriate health-care facility or hospital. The Member shall pay such transportation and any resulting charges.
The Provider is not contractually or otherwise liable to any Member or their family members for the denial of any of the Services by the Provider. The Provider is not liable for or otherwise responsible for any damage to, or loss or theft of, the personal property of any Member while receiving care by the Provider.
Each Provider is required to abide by any federal or state law, statute, rule or regulation in providing any of the Services. To the extent those requirements are incosistent or otherwise conflicts with this Agreement, those requirements shall control.
In the event that a government agency or entity challenges this Agreement of the Provider's ability to provide the Services or collect any fees thereunder, the Provider shall have the option and right to immediately terminate this Agreement. The Provider also retains the discretion to discontinue offering the Medical Membership Services to all Members. Should the Provider terminate this Agreement for the aforementioned reasons, the Member will be refunded the appropriate monthly pro-rated portion of their pre-paid membership fees.
No Member or their family members is entitled to rely upon any promise, representation, warranty, or other agreement that directly or indirectly relates to this Agreement, which has not been stated in this Agreement and such a promise, representation, warranty or other agreement hereby is waived. This Agreement may be changed only by a written amendment signed by the Member and the Provider.
The Agreement is governed exclusively by laws of the State of Georgia.
Any provision in this Agreement which is prohibited or unenforceable shall be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions thereof.
No failure or delay by a party to exercise any right or remedy provided under this Agreement or by law shall constitute a waiver of that or any other right or remedy, nor shall it preclude or restrict the further exercise of that or any other right or remedy. No single or partial exercise of such right or remedy shall preclude or restrict the further exercise of that or any other right or remedy.
Each Member (and by virtue of this Agreement, their family members listed on the enrollment form) acknowledges that he or she: (1) has reviewed and agrees to the entirety of this Agreement; (2) is of legal age and has the competency to knowingly enter into this Agreement; and (3) understands that he or she is oblicated to honor all the terms, provisions and conditions stated in this Agreement.