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; and (b) 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 entitled 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 (“Program”) offered by Moldco on behalf of its affiliated Provider practices and network physicians and providers including The Immune Co Medical Group, P.A. (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 for a separate contracted fee; (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 Program. You shall be entitled to receive the Covered Services. Membership in this Program 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 sixty (60) days advance written notice upon any change to the Covered Services.  You acknowledge that you are enrolling in the Program 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 Program and this Agreement is non-transferable.  The Program 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 Program or to terminate participation in any Program, for any reason, including abuse of the Program, 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.

3. Monthly Membership Fee. The monthly fee for the Covered Services in the Program is $______ (“Monthly Fee”). The Monthly Fee is subject to change. Notice of any such change will be provided to Patient no fewer than thirty (30) 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 Monthly Fee to Moldco for the Covered Services.  The Monthly Fee is due at the beginning of each subscription term and Moldco will charge the method of payment You provide in the amount of the Monthly Fee. The Monthly 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. There are no refunds for partially used Term periods. The Monthly 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 an Provider to another third party except to the extend specifically set forth in the definition of Covered Services.  The Monthly 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 Program covers a period of one (1) year (“Term”) which shall include twelve monthly subscription periods (each a “Subscription Periods”).  After the initial Term, the Program will automatically renew for subsequent one (1) year renewal periods, unless you cancel your subscription in the Program by notifying us at least thirty (30) days before the applicable renewal date that you wish to cancel your Program or do not wish to automatically renew your Term.  Notwithstanding anything herein to the contrary, You shall have the right to terminate during a Term effective the end of any Subscription Period without termination penalty by contacting support@moldco.com or using any functionality provided on the Platform through your Customer account. If you cancel at least five (5) calendar days before the end of the then-current Subscription Period, your cancellation will take effect at the end of that Subscription period, and you will continue to be able to use applicable Covered Services for the remainder of that Subscription Period. If you cancel less than five (5) calendar days before the end of the then-current Subscription Period, your cancellation will take effect at the end of the next Subscription Period, and you will continue to be able to use applicable Covered Services for the remainder of the then-current Subscription Period and the next Subscription Periods. The foregoing shall be adjusted as necessary under applicable law, and MoldCo will comply with any applicable legal requirements regarding subscriptions, renewals, and cancelations in your state.  Except as provided otherwise by law, You understand and agree that your Program 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 Monthly Fee(s) and any applicable taxes, for each such renewal,  If, for any reason, Moldco ceases to offer the Covered Services, then you will be entitled to a refund of any monthly fees paid in advance for the month(s) after Moldco ceases to offer health care services for any reason. Membership Fees shall not be pro-rated for any month.  All purchases for the Program are final.  Except as otherwise required by applicable law, any paid Monthly Fees (or payable Monthly Fees for the remainder of an existing Subscription Period) are non-cancellable and non-refundable.  MoldCo will consider requests for accommodation on a discretionary, case-by-case basis as to automatic renewals and cancelation requirements, and  may also in its sole discretion agree to “pause” your Membership for a limited, set period of time.

6. Services Excluded from Program and the Monthly Fee. The Monthly 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 Program 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; or (viii) 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 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.

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 understands 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 Program 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.

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, Network or its Providers will file any claims against any insurance policy or plan for reimbursement for any services you receive pursuant to this Program, and that obtaining a health care provider through the Program 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 Program.  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 Monthly Fee. Patient may not seek reimbursement of the Monthly 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.

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