Member Subscription Agreement
If you wish to participate as a subscriber of MoldCo’s direct care membership, 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 this Agreement; (b) that you have read and understood the MoldCo’s Terms of Use (www.moldco.com/terms) (the “Terms of Use”) and Privacy Policy (www.moldco.com/privacy) (the “Privacy Policy”), which are incorporated by reference into this Agreement; and (c) that this 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 5entitled to participate as a subscriber.
This Agreement and the terms and conditions set forth specify the terms and conditions under which you, the undersigned patient (“Patient”), may participate in the direct health care membership program for diagnosis and treatment of mold related illnesses (the “Membership”) offered by The Immune Co. d/b/a MoldCo (“MoldCo”), a Delaware corporation, on behalf of its affiliated Provider (as defined below) practices and network physicians, including, without limitation, The Immune Co Medical Group, P.A., a Florida professional association, New York Opus Medical Services, P.C., a New York professional corporation, Immune Co Medical Group West PC, a California professional corporation, and future Provider practices and network physicians (the “Network”).
1. Definitions.
A. Providers means appropriately licensed health care providers providing professional services hereunder who independently contract to participate in MoldCo’s Network to provide certain digital and/or virtual telehealth services.
B. Covered 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 Covered Services may be revised from time to time in the licensed physician’s and MoldCo’s sole discretion. Covered 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, Covered Services includes the following only: (a) eligibility questionnaire for review by your Network Provider; (b) a one-time synchronous visit with a Network Provider; (c) unlimited asynchronous messaging with your Network clinician each month; (d) unlimited asynchronous messaging with a care navigator each month; (e) unlimited asynchronous messaging with technical support each month; (f) access to MoldCo’s Platform including educational materials; (g) access to lab tests as ordered by your Network Provider and performed and independent third party contracted labs subject to a separate contracted fee for such tests and services; (h) access to monthly prescription treatments and medications dispensed and delivered by independent third party contracted pharmacies (or the pharmacy of your choice) for a separate fee as prescribed by your Network Provider; and (i) access to any other promotions and discounts on selected products if offered by MoldCo.
2. Membership Enrollment. You hereby agree to enroll as a subscriber in the Membership. You shall be entitled to receive the Covered Services during each monthly Term (as defined in Section 5). Membership in this Membership includes only the Covered Services and no other services. MoldCo may add or discontinue Covered Services at any time, in its sole discretion to the extent permitted under applicable law. You will be provided at least five (5) calendar days advance written notice upon any change to the Covered Services. You acknowledge that you are enrolling in the Membership voluntarily. By enrolling in the program, you are agreeing to be bound by these terms and affirming that you are of legal age to enter into this Agreement. The Membership and this Agreement are non-transferable. The Membership 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 the Membership or to terminate participation in any Membership, for any reason, including abuse of the Membership, 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 this or any other membership or subscription program offered by MoldCo. Subject to Section 5 below, MoldCo may terminate the Membership and/or your ability to use the Covered Services at any time and for any reason, including, without limitation, for any violation or breach of this Agreement, the Terms of Use, or if MoldCo terminates all or part of the Covered Services.
3. Recurring Membership Fee. The monthly fee for the Covered Services in the Membership is $79.00 (“Recurring Membership Fee”). The Recurring Membership Fee is subject to change. Notice of any such change will be provided to Patient at least five (5) calendar days prior to the end of the then current Term (as defined herein), with such change taking effect with the commencement of the next Term. You will pay the Recurring Membership Fee to MoldCo for the Covered Services. The Recurring Membership Fee is due at the time you enroll and pay for the Membership, which commences the subscription Term (the “Billing Start Date”) and MoldCo will charge the method of payment you provide in the amount of the Recurring Membership Fee. The Recurring Membership 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 Recurring Membership Fee only covers the rendering of the Covered 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 Provider to another third party except to the extent specifically set forth in the definition of Covered Services. The Recurring Membership 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.
4. Relationship between Providers and MoldCo. You understand and acknowledge that each Provider is an independent contractor to MoldCo or the Network, and is not the agent, servant or employee of MoldCo or the Network. You further agree and understand that MoldCo does not provide, supervise or control the care that you receive from a Provider. Rather, your care is furnished and directed solely by the 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 Provider who renders the Covered Services and/or other care to you. MoldCo makes no representations or warranties about the quality, qualifications, or experience of the Provider or the Covered Services and/or other care such Provider provides.
5. Renewals and Termination. The Membership period covers a calendar monthly and starts on the Billing Start Date and ending on the last calendar day of a month (each calendar month is a “Term”), automatically renewing at each monthly anniversary of your Billing Start Date (each a “Billing Date”), unless noticed by you or MoldCo for cancellation or termination subject to this Section 5. In the event your there is no corresponding monthly anniversary of your Billing Start Date, the Billing Date shall be the last calendar day of the applicable month. The Membership will automatically renew for subsequent Terms or renewal periods on each Billing Date, unless either MoldCo or you cancel your subscription in the Membership according to the following. s sole discretion agree to “pause” your Membership for a limited, set period of time.
A. Terminations by MoldCo. If MoldCo elects to terminate your membership, termination of your Membership, for any reason or no reason, the last day of your Membership shall be the last day of the subsequent Term before the next Billing Date thereafter (the “Termination Period”). During the Termination Period, MoldCo shall have rights to charge and deduct the Recurring Membership Fee covering the Termination Period. By way of example, if your Billing Date is every 28th of a month, and MoldCo decides to terminate your Membership on the 15th of July, then your Membership terminates on the 27th of August, and you are responsible for payment of the Recurring Membership Fee and MoldCo shall have rights to deduct such amount on the 28th of July. During the Termination Period, MoldCo shall not obligated to refill any prescriptions, unless MoldCo decides, in its sole and reasonable discretion, that a medical necessity or emergency exists for a refill. You agree that MoldCo is not entitled to offer any refund and you are obligated to pay the full Recurring Membership Fe during the Termination Period.
B. Terminations by You. If you elect to terminate your Membership, for any reason or for no reason, termination of your Membership is effective only if you provide five (5) calendar days’ notice of such termination before the next Billing Date. Otherwise, your Term will renew on the next Billing Date and you must pay the Recurring Membership Fee. You acknowledge and agree that MoldCo does not issue refunds or any pro-rated amounts, and any amounts, otherwise, shall be subject to MoldCo’s sole discretion on a case by case basis. In the event, you fail to pay the Recurring Membership Fee, MoldCo will provide notice for you to cure the issue of non-payment, and is entitled to suspend your Membership during such period (the “Membership Suspension Period”). During the Membership Period, you acknowledge and agree that MoldCo, in its sole discretion, may “pause” or suspend any or all of the Covered Services until all amounts due to MoldCo are paid and current. If you fail to pay the amounts owed to MoldCo during the Membership Suspension Period, then MoldCo will deem your Membership as terminated by you.
Terminations of the Membership can occur by contacting support@moldco.com, communicating through the chat box function, or any similar features and functions offered by the MoldCo Platform, from time to time, accessible through your MoldCo account. Except as provided otherwise by law, you understand and agree that the Membership will automatically continue for additional periods, unless you cancel or do not renew in accordance with this Agreement, and you authorize MoldCo (without notice to you, unless required by applicable law) to collect and charge the then-applicable Recurring Membership Fee(s) and any applicable taxes, for each such renewal on each Billing Date. MoldCo reserves its right to consider requests for a refund on a discretionary, case-by-case basis.
6. Services Excluded from Membership and the Recurring Membership Fee. The Recurring Membership Fee specified herein covers only the defined Covered Services. Neither MoldCo nor your Provider or her staff will seek reimbursement from any insurer or other third-party payer for the Covered Services. Patient shall be responsible for any charges incurred for health care services including Excluded Services provided by Provider that are not expressly identified in the Covered Services.
7. Non-Covered Services. Patient shall be responsible for any charges incurred for health care services provided by Providers that are not expressly identified in the Covered Services. The Membership and Covered Services do not cover any of the following services not expressly included in the Covered Services: (i) any ancillary services; (ii) any services provided by any party other than Providers; (iii) hospital services, emergency room visits, or urgent care facility visits; (iv) appointments with other providers or specialists referred to you by a Provider; (v) radiology; (vi) lab tests by outside companies not specifically affiliated with MoldCo; (vii) durable medical equipment; (viii) additional synchronous visits with a Network Provider; (ix) psychiatric or mental or behavioral health services; (x) prescriptions for pharmacies outside of the Network of Providers; or (xi) any services not expressly listed as included in the Covered Services (collectively, the “Excluded Services”). You acknowledge that neither MoldCo nor any Provider is responsible for any medical bills, or any other amounts incurred for any Excluded Services, even if your Provider referred you for such services. If your Provider makes an outside referral, you should contact your insurance provider, if any, to check your coverage for such referred service. In the event you request a prescription ordered by a Provider to be fulfilled at a pharmacy outside of the Network, You agree to pay the then current administrative service fee for fulfillment (which can be modified depending on case) of your prescription at your designated pharmacy.
8. Limitations and Additional Representations
A. Clinical Services. All clinical diagnoses and treatment determinations are based solely on the Provider’s individualized evaluation of clinical appropriateness and medical necessity made during a visit, and under no circumstances shall Network or its Providers guarantee or ensure a particular treatment or clinical outcome as a result of the Covered Services.
B. No Controlled Substances. You understand and acknowledges that no DEA controlled substances, narcotics, psychotropic medications or lifestyle drugs will be prescribed by any Provider via the Covered Services.
C. Emergency Services. You understand that if in the Provider’s sole medical judgement, the consult involves a life-threatening emergency, Provider may direct you to the nearest emergency facility.
D. Providers. You understand and acknowledge that Providers participating in the Membership may change from time to time and that from time to time certain Providers may no longer be able to accept new members due to patient volume limits. If your chosen Provider is no longer available, MoldCo will notify you of such unavailability and offer an alternative Provider.
E. Provider/Patient Relationship. You understand that in order to receive any Covered 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 Telehealth Consent Form and any additional intake forms and confirming an understanding that the Provider is not obligated to accept you as a patient.
1. Completing a Medical History Disclosure; and
2. Agreeing to the Telehealth Consent Form and any additional intake forms and confirming an understanding that the Provider is not obligated to accept you as a patient.
9. Not Insurance. YOU ACKNOWLEDGE AND UNDERSTAND THAT NEITHER THIS AGREEMENT NOR THE PROGRAM IS 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’s Network or its Providers will file any claims against any insurance policy or plan for reimbursement for any services you receive pursuant to this Membership, and that obtaining a health care provider through the Membership 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 Covered Services that you receive under the Membership. The Covered 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 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 Providers will bill insurance companies or Medicare on your behalf for Covered Services or for the Recurring Membership Fee. Patient may not seek reimbursement of the Recurring Membership Fee from any insurance company or health care plan, including Medicare, for any of the Covered Services or for any other services that 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 Covered Services with any health plan, insurer, or other payor.
11. Billing. Initial payments are processed at the time of enrollment. Subsequent payments are charged monthly.
12. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the state of Texas, except as otherwise provided herein.
13. Assignment/Binding Effect. This Membership Agreement shall be binding upon and shall inure to the benefit of MoldCo, Network, Provider and Patient and their respective successors, heirs and legal representatives. Neither this Membership 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.
- 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.