Charity Provider Patient User Agreement
If you wish to access and use the Services as described in the MoldCo Terms of Use (https://www.moldco.com/terms), Informed Consent for Telehealth Services, and Notice of Privacy Practices (collectively, this Charity Provider Patient User Agreement, MoldCo Terms of Use, Informed Consent for Telehealth Services, and Notice of Privacy Practices are the “Agreement”), you must click on the “I accept the terms and conditions of this Agreement” button. By clicking the “I accept the terms and conditions of this Agreement” button you acknowledge: (a) that you have read and understood each Agreement; and (b) that each Agreement has the same force and effect as an agreement signed with original signatures. If you do not click on the “I accept the terms and conditions of this Agreement” button you will not be entitled to access any of the Services. All undefined capitalized terms shall have the meaning ascribed to such term as found in the MoldCo Terms of Use and Informed Consent for Telehealth Services.
Each of the Agreements set forth specify the terms and conditions under which you, the undersigned patient (“Patient”), may use the MoldCo Platform in order to access and certain Healthcare Services provided by a Charity Provider.
1. Definitions.
A. Charity Provider means any appropriately licensed health care provider or providers who are employees or service providers, contracted or associated, with the Christian Medical Ministries, Inc., a Florida not-for-profit corporation, to provide professional services hereunder, specifically certain digital and/or virtual telehealth services. This also includes the administrative staff of Christian Medical Ministries who assist in the coordination and delivery of these services, including but not limited to managing patient intake, scheduling, and facilitating communication between patients and healthcare providers.
B. Charity Provider Services means diagnosis and treatment of certain mold related illnesses including the management of mold related conditions or the creation and management of a long-term personalized care plan to you upon completion of the clinical intake process, including, without limitation, access to certain prescriptions and prescription refills (non-narcotics), access to care team during the listed hours, care coordination/referrals to “in-person” care when clinically appropriate. The conditions excluded or included in the Charity Provider Services may be revised from time to time in the Charity Provider’s licensed physician’s sole discretion. The Charity Provider Services may include, if medically necessary, referrals and orders for care from third party providers (e.g., prescription, imaging, laboratory tests, in-person treatment). Specifically, the Charity Provider Services includes the following only: (a) eligibility questionnaire for review by your Charity Provider; (b) synchronous visit with a Charity Provider; (c) asynchronous messaging with a Charity Provider; (d) access to MoldCo’s platform including educational materials; and (e) access to certain prescription treatments and medications, if prescribed by your Charity Provider, will be dispensed and delivered by independent third party contracted pharmacies (or the pharmacy of your choice) subject to your payment of applicable shipping and dispensing fees and costs. Some of the Charity Provider services may also include (x) access to lab tests as ordered by your Charity Provider and performed by independent third party contracted labs for a separate contracted fee; and (y) access to any other promotions and discounts on selected products and services if offered by MoldCo. Certain Charity Provider Services includes the prescribing of medication donated directly by Americares Foundation, Inc. (“Americares”).
2. Use of the Charity Provider Services. You hereby agree to use the Charity Provider Services in accordance with the terms of the Agreement. The Charity Provider Services includes only the Charity Provider Services and no other services. MoldCo may add or discontinue the Charity Provider Services at any time, in its sole discretion to the extent permitted under applicable law. You will be provided at least sixty (60) days advance written notice upon any change to the Charity Provider Services. You acknowledge that you are accessing and using the Charity Provider Services voluntarily. By accessing and using the Charity Provider Services, you are agreeing to be bound by these terms and affirming that you are of legal age to enter into this Agreement. None of the rights and obligations of the Agreement are transferable. Your account must be associated only with a single individual over the age of legal majority in the applicable jurisdiction. MoldCo reserves the right, in its discretion, to exclude any individual(s) from access or to terminate participation in the Charity Provider Services, for any reason, including abuse of the Charity Provider Services, failure to comply with this Agreement, or fraud, misrepresentation, or other conduct detrimental to the interests of MoldCo. Any such exclusion or termination may affect eligibility for further participation in these Charity Provider Services, or any other membership or subscription program offered by MoldCo.
3. Platform Fee. You agree to pay a one-time platform fee for access to and use of the Charity Provider Services in the amount of $20.00 (“Platform Fee”). The Platform Fee is a one-time charge, which is subject to change at MoldCo’s sole discretion, that grants you access to the Charity Provider Services and ongoing access to the MoldCo Platform, subject to limited access to certain features or functionalities as determined by MoldCo in its sole and reasonable discretion, including but not limited to access to certain medication, educational resources, or support services.. The Platform Fee is due at the beginning of your account creation with MoldCo, for which MoldCo will charge the method of payment that You provide in the amount of the Platform Fee. The Platform Fee does not include taxes, duties, levies, tariffs, and other governmental charges (including, without limitation, VAT) (collectively, “Taxes”). You shall be responsible for payment of all Taxes and any related interest and/or penalties resulting from any payments made hereunder, other than any taxes based on MoldCo's net income. You agree to provide MoldCo with alternate payment card information if the payment card MoldCo has on file for you is no longer valid, or if You choose to use a different payment card.
The Platform Fee only covers the rendering of the Charity Provider Services, and shall not cover the cost of any diagnostic or other laboratory tests, prescription medications or medical devices, specialty medical care rendered by any third party, or any other referral made by a Charity Provider to another third party except to the extend specifically set forth in the definition of Charity Provider Services. The Charity Provider reserves the right to charge additional fees or costs applicable to services rendered, including but not limited to administrative fees, processing fees, or costs associated with third-party services. If an account is terminated, whether by the Patient, MoldCo, or the Charity Provider, and subsequently reinstated or reestablished, MoldCo reserves the right to charge the Platform Fee again upon the creation or renewal of the account. The Platform Fee and terms may change from time to time; however, we will provide You with advance notice (via the Platform or otherwise) of such changes. There are no refunds of the Platform Fee, and any other third party fees and costs, such as costs for shipping or lab testing. MoldCo reserves, in its sole and reasonable discretion, whether a refund is warranted.
4. Relationship between Charity Providers and MoldCo. You understand and acknowledge that each Charity Provider is an independent contractor to MoldCo, and is not the agent, servant or employee of MoldCo. You further agree and understand that MoldCo does not provide, supervise or control the care that you receive from a Charity Provider. Rather, your care is furnished and directed solely by the Charity Provider who exercises such provider’s own professional judgment in the practice of medicine or other applicable profession. MoldCo is not responsible for the judgment or conduct of any Charity Provider who renders the Charity Provider Services and/or other care to you. MoldCo makes no representations or warranties about the quality, qualifications, or experience of the Charity Provider or the Charity Provider Services and/or other care such Charity Provider provides. Furthermore, any administrative staff, contractors, or other personnel employed by or associated with the Charity Provider are likewise not agents, servants, or employees of MoldCo, and MoldCo disclaims all liability for their actions or omissions in connection with the provision of any services.
5. Termination. The Patient acknowledges and agrees that access to the Charity Provider Services, the Platform, or any other Services does not confer any right to a specified term or period of time under this Agreement. MoldCo and the Charity Provider reserve the right to terminate this Agreement at any time, for any reason, without prior notice. Such termination shall be effective immediately upon notice from MoldCo or any Charity Provider, as applicable. Upon termination, the Charity Provider may engage the Patient in a discharge process. You further confirm that you have read and understood this Section 5 and any related language in the Agreement.
6. Services Excluded from the Charity Provider Services and the Platform Fee. The Platform Fee specified herein covers only the defined Charity Provider Services. Neither MoldCo nor your Charity Provider or her staff will seek reimbursement from any insurer or other third-party payer for the Charity Provider Services. Patient shall be responsible for any charges incurred for health care services including Excluded Services (as defined below) provided by Charity Provider that are not expressly identified in the Charity Provider Services.
7. Non-Charity Provider Services. Patient shall be responsible for any charges incurred for health care services provided by Charity Providers that are not expressly identified in the Charity Provider Services. The Charity Provider Services do not cover any of the following services not expressly included in the Charity Provider Services: (i) any ancillary services; (ii) any services provided by any party other than Charity Providers; (iii) hospital services, emergency room visits, or urgent care facility visits; (iv) appointments with other providers or specialists referred to you by a Charity Provider; (v) radiology; (vi) lab tests by outside companies not specifically affiliated with MoldCo; (vii) durable medical equipment; or (viii) any services not expressly listed as included in the Charity Provider Services (collectively, the “Excluded Services”). You acknowledge that neither MoldCo nor any Charity Provider is responsible for any medical bills incurred for any Excluded Services, even if your Charity Provider referred you for such services. If your Charity Provider makes an outside referral, you should contact your insurance provider, if any, to check your coverage for such referred service.
8. Limitations and Additional Representations
A. Clinical Services. All clinical diagnoses and treatment determinations are based solely on the Charity Provider’s individualized evaluation of clinical appropriateness and medical necessity made during a visit, and under no circumstances shall Charity Providers guarantee or ensure a particular treatment or clinical outcome as a result of the Charity Provider Services.
B. No Controlled Substances. You understand and acknowledge that no DEA controlled substances, narcotics, psychotropic medications or lifestyle drugs will be prescribed by any Charity Provider via the Charity Provider Services.
C. Emergency Services. You understand that if in the Charity Provider’s sole medical judgement, the consult involves a life-threatening emergency, Charity Provider may direct you to the nearest emergency facility.
D. Providers. You understand and acknowledge that Charity Providers participating in the Charity Provider Services may change from time to time and that from time to time certain Charity Providers may no longer be able to accept new members due to patient volume limits. If your chosen Charity Provider is no longer available, your Charity Provider will notify you of such unavailability and offer an alternative provider.
E. Charity Provider/Patient Relationship. You understand that in order to receive any of the Charity Provider Services, you are required to complete the necessary steps to create a provider/patient relationship via Telephone or Video, in accordance with applicable state and federal laws. Those steps include, but are not limited:
1. Completing a Medical History Disclosure; and
2. Agreeing to the Informed Consent for Telehealth Services Form and any additional intake forms and confirming an understanding that the Charity Provider is not obligated to accept you as a patient.
9. Not Insurance. YOU ACKNOWLEDGE AND UNDERSTAND THAT NEITHER THIS AGREEMENT NOR THE COVERED SERVICES ARE INSURANCE. THIS AGREEMENT DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE, IS NOT A CONTRACT OF INSURANCE, AND IT IS NOT REGULATED BY THE INSURANCE LAWS OF YOUR STATE OR ANY OTHER STATE. The Agreement does not meet any individual health insurance mandate that may be required by federal or state law. You acknowledge that you are not entitled to health insurance protections for consumers under any state or federal laws. You additionally acknowledge that none of MoldCo, its network of providers, or the Charity Provider will file any claims against any insurance policy or plan for reimbursement for any services you receive pursuant to the Charity Provider Services, and that obtaining a health care provider through the Charity Provider Services will likely not qualify for any primary care provider requirement that exists in a third-party insurance plan. If you have an insurance policy, your insurance may include, at no additional charge, some of the Charity Provider Services that you receive hereunder. The Charity Provider Services should not be utilized for emergency medical problems. This provision shall survive termination of this Agreement. For the sake of clarity, THIS AGREEMENT IS NOT HEALTH INSURANCE AND THE CHARITY PROVIDER WILL NOT FILE ANY CLAIMS AGAINST THE PATIENT’S HEALTH INSURANCE POLICY OR PLAN FOR REIMBURSEMENT OF ANY HEALTH CARE SERVICES COVERED BY THE AGREEMENT. THIS AGREEMENT DOES NOT QUALIFY AS MINIMUM ESSENTIAL COVERAGE TO SATISFY THE INDIVIDUAL SHARED RESPONSIBILITY PROVISION OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. THIS AGREEMENT IS NOT WORKERS’ COMPENSATION INSURANCE AND DOES NOT REPLACE AN EMPLOYER’S OBLIGATIONS UNDER STATE LAW. THIS AGREEMENT DOES NOT CONSTITUTE INSURANCE AND IS NOT SUBJECT TO THE STATE INSURANCE LAWS, NOR DOES THE ACT OF ENTERING INTO A DIRECT HEALTH CARE AGREEMENT CONSTITUTE THE BUSINESS OF INSURANCE.
10. Medicare and Insurance Claims. You acknowledge and understand that neither MoldCo or any Charity Providers will bill insurance companies or Medicare on your behalf for Charity Provider Services or for the Platform Fee. Patient may not seek reimbursement of the Platform Fee from any insurance company or health care plan, including Medicare, for any of the Charity Provider Services or for any other services that Charity Provider provides Patient. You acknowledge and agree that some services may be a covered benefit or covered service under Patient’s health benefit plan. However, you agree that you may not file a claim for the Charity Provider Services with any health plan, insurer, or other payor.
11. Third-Party Service Providers. You acknowledge and agree that Charity Provider and MoldCo may utilize certain third-party service providers to implement and effectuate certain Charity Provider Services. This includes, without limitation, the dispensing and shipping of medication donated by Americares, or the ordering of lab tests and results. You further agree to comply with any terms and conditions set forth by these third-party service providers, as applicable to You, such as, without limitation, the payment of any related shipping costs, and acknowledge that such terms and conditions may affect MoldCo or Charity Provider’s provision of any services offered under this Agreement.
12. Litigation Activity. You acknowledge and understand that the Charity Provider Services and the Platform Services do not cover or include any disputes, pre-litigation, or litigation (collectively, "Disputes"). You further agree that neither MoldCo nor the Charity Provider will participate in any Disputes to the fullest extent permissible under applicable laws.
13. Billing. Initial payments are processed at the time of enrollment. Subsequent payments are charged monthly.
14. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the state of Florida, except as otherwise provided herein.
15. Assignment/Binding Effect. This Agreement shall be binding upon and shall inure to the benefit of MoldCo, Charity Provider, and Patient and their respective successors, heirs and legal representatives. Neither this Agreement, nor any rights hereunder, may be assigned by the Patient without written consent of MoldCo.
I AGREE TO THE TERMS AND CONDITIONS OF THIS AGREEMENT AND EXPRESSLY AGREE TO THE FOLLOWING:
- This Agreement is for ongoing primary care and is NOT a medical insurance agreement.
- Charity Provider will not file any third-party insurance claims on my behalf.
- This Agreement does not meet the individual insurance requirement of the Affordable Care Act.
- This Agreement is non-transferrable.