NOTICE: a. The agreement does not constitute health insurance of the laws of this state. b. An uninsured patient that enters into an agreement may still be subject to tax penalties under the Patient Protection and Affordable Care Act, Public Law 11 111-148, for failing to obtain insurance. c. Patients insured by health insurance plans that are compliant with the Patient Protection and Affordable Care Act already have coverage for certain preventive care benefits at no cost to the patient. d. Payments made by a patient for services rendered under a physician agreement or dentist agreement may not count toward the patient’s health insurance deductibles and maximum out-of-pocket expenses. e. A patient is encouraged to consult with the patient’s health insurance plan before entering into the agreement and receiving care.
Everside Health is not an insurance company, and the guidelines and plan operation are not an insurance policy. Participation in Everside Health’s plan or a subscription to any documents should not be considered to be a health insurance policy. Regardless of whether you receive treatment for medical issues through Everside Health, you are always personally responsible for the payment of any additional medical expenses you may incur.
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided below. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.
The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.
NOTICE: This direct primary care agreement is not health insurance and is not a plan that provides health coverage for purposes of any federal mandate. This direct primary care agreement only covers the primary health services described in this agreement. It is recommended that you obtain health insurance to cover health care services not covered under this direct primary care agreement. You are personally responsible for the payment of any additional health care expenses you may incur.
This agreement does not provide comprehensive health insurance coverage. It provides only the health care services specifically described. You are responsible for any services as described in section ‘Billing and Insurance’. You are encouraged to obtain and maintain insurance for services not provided by Everside Health. Everside Health will not bill a health insurance issuer for services covered under this Membership Agreement. The Louisiana Board of Medical Examiners’ may be contacted at: https://www.lsbme.la.gov.
The fees charged in the agreement may not be reimbursed or apply towards a deductible under a health insurance policy with an insurer.
Without adequate insurance coverage in addition to this agreement, you may be subject to fines and penalties associated with the federal Affordable Care Act.
The Membership Agreement does not provide comprehensive health insurance coverage. It provides only the provision of primary care as specifically described in the Agreement.
Services available to Washington State patients include:
- Primary and preventive Care (acute illness visits and treatments, basic vision screening, biometric screening, chronic condition management, comprehensive personal evaluation, coordination with other providers, depression and anxiety, fitness and nutrition coaching, health risk assessment, administration of immunizations and injections, lifestyle and risk-reduction coaching, pediatric visits, pre-op evaluations and clearance, routine adult physicals, sports physicals, women’s health)
- Procedures (asthma/pulmonary treatments, basic ENT procedures, basic wound care, dermatological procedures including mole removal, ingrown toenail removal, skin cyst removal, skin tag and wart removal, stitches, suture/staple removal)
- In-Office laboratory services (basic metabolic panel, glucose, hemoglobin A1C, hemoglobin, lipid panel, microalbumin-creatinine ratio)
- Behavioral health (anxiety assessment and treatment, depression assessment and treatment, mental health medication management)
- Diagnostic testing and vital (blood pressure and vital signs, EKG, peak flow testing, spirometry)
Registration Fees and Payments
In Washington state, registration fees are waived and Everside Health cannot enter into payment relationships whereby a health plan is responsible for paying the monthly membership fee.
Washington state patients are entitled to receive a prompt refund of all unearned direct fees following Everside Health’s receipt of written notice of termination of the Membership Agreement. The notice of termination becomes effective on the last day of the thirty-day transition of care.
So long as Everside Health provides the patient notice and opportunity to obtain care from another physician, Everside Health may discontinue care for direct patients if: (a) The patient fails to pay the membership fee under the terms required by the membership agreement; (b) the patient has performed an act that constitutes fraud; (c) the patient repeatedly fails to comply with the recommended treatment plan; (d) the patient is abusive and presents an emotional or physical danger to the staff or other patients of Everside Health; or (e) Everside Health discontinues operation as a direct practice.
Membership Fees and Fee Schedule
The membership fee and fee schedule for existing Washington state patients is not increased more than once annually and any change is announced in writing at least 60 days in advance.
Washington State Comprehensive Disclosure Statement
This agreement does not provide comprehensive health insurance coverage. It provides only the health care services specifically described. Individuals are encouraged to obtain and maintain insurance for services not provided by Everside Health. Everside Health will not bill an insurance carrier for services covered under the membership agreement.
The Washington Office of the Insurance Commissioner may be contacted at:
via email at email@example.com, or Toll Free: 800-562-6900.