Paticipating Members agree to be bound by the following terms and conditions with SIMPLE HEALTH.
Some of the terms and conditions below may not apply to their current product or membership level. As members purchase upgrades and additional products, these terms and conditions may become applicable to the membership level at the current time.
1. LIFESTYLE AND WELLNESS PROGRAMS BENEFITS DISCLOSURES: SIMPLE HEALTH supports Members Lifestyle and Wellness programs that offer enhanced wellness opportunities, personal advice and discount savings on selected nonmedical services.
2. QUESTIONS / ISSUE RESOLUTION: If members have any questions about your membership, they can call the toll-free member services number provided to them upon enrollment.
3. FEES AND TERMINATION: Member agrees to pay the monthly Individual or Family membership cost and any other fees member approved and confirmed during the member's voice recorded verifications for the term of the Agreement and any renewals. Additionally, members agree that all fees will automatically be debited on the monthly billing date of the member's renewal and any other services. If the credit card or checking account on file for the member is declined for payment of member's fees, member has ten (10) days to provide another credit card or checking account, or membership and any other services will be cancelled. If the new card or account member provides is successfully charged, membership and/or other services will remain in effect based on member's original renewal date and not the date of the successful charge. SIMPLE HEALTH reserves the right to terminate members' plans without notice for non-payment of monthly plan fees. Members requiring assistance with monthly payments should contact Member Services for assistance. When applicable, administrative fees disclosed and accepted during recorded verification for prescription advocacy is due in full for the entire term on the advocacy. This will survive cancellation or termination of the underlying membership. A returned check fee of $25.00 will be imposed for monthly payments made by check that are not honored by member's financial institution. This returned check fee and associated monthly member fee are due and payable immediately and member's failure to pay the returned check fee and associated monthly membership fee will result in termination of membership for non-payment, without notice to member.
4. MEMBERSHIP ACTIVATION: Member's plan becomes active on Effective Date (the "Effective Date"). The Effective Date is typically one (1) day after enrollment date and will be determined by the date of initial payment receipt, including any applicable enrollment fee.
5. AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION: Members authorize SIMPLE HEALTH and its representatives to use and/or disclose certain protected health information (PHI) about member and/or their spouse or dependents to prescription drug manufacturers and providers. This authorization permits SIMPLE HEALTH to use and/or disclose individually identifiable health information about member's prescription drug information. The information will be used or disclosed for the following purpose: for administrative and advocacy services in enrolling in pharmaceutical companies' patient assistance programs. Additionally, members authorize use and/or disclosure of certain protected health information (PHI) to review members completed Health Wellness Assessment Survey and provide member with suggestions for prospective utilization of partners' products and services. This authorization will expire upon the date of termination of membership.
Members have the right to revoke this authorization in writing except to the extent that SIMPLE HEALTH has acted in reliance upon this authorization. Written revocation must be submitted to:SIMPLE HEALTH PLANS
FORT LAUDERDALE, FL 33306
6. PRESCRIPTION SAVINGS PROGRAM (PSP): Eligible members that utilize the PSP program agree to pay the following: (i) Monthly administrative service fee for Individual or Family membership during the term of this Agreement and any renewals; and (ii) agree to pay for pricing discussed during voice recorded verification upon pharmaceutical manufacturer approval of medication. SIMPLE HEALTH is not affiliated with any pharmaceutical companies and does not dispense medications. SIMPLE HEALTH does not receive payment from pharmaceutical companies, only from members as a service fee to complete administrative duties. SIMPLE HEALTH cannot determine eligibility until each pharmaceutical company has reviewed member's application and made an eligibility decision. SIMPLE HEALTH is not an insurance RX drug plan or any type of insurance. Doctor's participation and prescription is required for each application. Proper identification and documentation, i.e.: proof of income and US Government ID, may be required for each medication application.
7. DISCLAIMER: As SIMPLE HEALTH is not an insurer, HMO or underwriter of healthcare services, SIMPLE HEALTH does not pay or reimburse providers' fees, nor make payments directly to providers of medical services. Participating providers may change without notice and programs may vary by state. This program and contract are not protected by any state Health and Life Guarantee Association. Members acknowledges that the provider networks may have access to personal information protected by Health Insurance Portability and Accountability Act (HIPAA) and approves the limited use of such information by the networks.
8. CANCELLATION POLICY:Members identified as the primary account holder may cancel their membership any time by calling toll free or by providing a signed letter of cancellation notice including membership number to SIMPLE HEALTH at the following address: SIMPLE HEALTH, HOLLYWOOD, FL 33020 or via email at: firstname.lastname@example.org.
9. CHANGE IN TERMS AND CONDITIONS: Membership features and benefits may be modified, withdrawn and/or subject to additional terms and conditions at any time as the program evolves. SIMPLE HEALTH reserves the right to change or terminate any terms, conditions, services or benefits without limitation. Prior notice of any material change will be provided to members whenever possible, if required by law. Lifestyle and Wellness Features and Benefits availability are subject to state regulation.
10. LIMITATION OF LIABILITY: SIMPLE HEALTH does not warrant any professional services on behalf of participating providers and facilities which are solely responsible for their professional advice, services and treatment rendered to Members, and their affiliates and SIMPLE HEALTH expressly disclaim any liability with respect to such matters. SIMPLE HEALTH SHALL NOT BE LIABLE FOR ANY DAMAGES WHATSOEVER, AND SIMPLE HEALTH SHALL NOT BE LIABLE FOR ANY SPECIAL, INDIRECT, CONSEQUENTIAL, OR INCIDENTAL DAMAGES, OR ANY DAMAGES FOR LOST PROFITS, LOSS OF REVENUE, OR LOSS OF USE, ARISING OUT OF OR RELATED TO THE SERVICE OR THE INFORMATION CONTAINED IN IT, WHETHER SUCH DAMAGES ARISE IN CONTRACT, NEGLIGENCE, TORT, UNDER STATUTE, IN EQUITY, AT LAW, OR OTHERWISE, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
11. INDEMNIFICATION: Members agree to indemnify and hold harmless SIMPLE HEALTH (and its parents, directors, officers, employees, subsidiaries, agents, and affiliates) from all claims, liabilities, costs, and expenses, including reasonable attorney’s fees and costs, due to or arising in any way from the use or misuse by member of WPA products and/or services member violation of these Terms and Conditions, member violation of any law, or infringement by member of any right of any person or entity.
12. GOVERNING LAW, SEVERABILITY OF PROVISIONS: This Agreement shall be governed by, construed and enforced in accordance with the laws of the State of Florida. Captions provided herein are for convenience only and shall not be used in interpretations of the respective sections. If any portion or clause of any provision of this Agreement which is deemed prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof or thereof or affecting the validity or enforceability of such provision in any other jurisdiction.
(b) Members agree that all damages, costs and expenses including reasonable attorney's fees incurred by SIMPLE HEALTH and/or its representatives arising in any manner associated with the membership agreement or any claim brought by Member or SIMPLE HEALTH shall be paid by Member. No action, whatsoever its form, which arises out of the agreement, may be brought by either party more than one year after Member's membership effective date.