Terms and Conditions for Medical Membership
1. MEMBERSHIP IS NOT AN INSURANCE POLICY:
• Individual understands that they are purchasing a membership to an
identified group in order to receive access to a discounted rate plan for
medical services.
• That discounted rate plan is being offered by Davam Urgent Care/Davam
Family Medicine clinics and covers services provided only at their clinic
locations.
• Member understands that this is NOT an insurance plan.
• Member should not consider it to be an insurance plan or intend to use it
as a substitute for an insurance plan.
2. DEFINITIONS:
• Membership: For the purpose of these “Terms and Conditions”
Membership is defined as an agreement entered into voluntarily by all
parties. Terms of Membership provide that for an established monthly
rate, the member receives standard medical care as then provided in the
normal course of business by Davam Urgent Care/Davam Family
Medicine at a pre-established discounted rate.
• Member: The term which identifies the individual wishing to be provided
with a membership to the Davam Urgent Care/Davam Family Medicine
Medical Membership Program.
• Minor: Will have the same meaning as that established by the State of
Texas.
• Dues: The monthly rate charged by Davam Urgent Care/Davam Family
Medicine for inclusion in the Medical Membership Program.
• Family Member: Immediate family members living in the home of the
Member (husband, wife, children and stepchildren).
• Provider: Physician
3. MEMBERSHIP RESTRICTIONS:
• A Member’s privileges are subject to their having no outstanding amounts
due to Davam Urgent Care/Davam Family Medicine.
• Member must present a current picture ID in order to receive Membership
benefits.
• Dues will be charged and deducted on a monthly or yearly basis.
• Minors may not be seen by staff without a parent or a legal guardian being
present or having signed a consent form on file, or as defined by state law.
• Membership rates and hours of use are subject to change without notice.
• This membership is non-transferable.
• The monthly membership operates on a 12-month term. Early
cancelation is subject to a $199 cancelation fee.
4. MEMBERSHIP RATES:
• Members choosing the Monthly Membership Plan will be responsible for
Dues of $55 per month, which will include a $50 signup fee. Members
choosing the Yearly Membership Plan will be responsible for Dues of $599
annually and $50 signup fee will be waived.
• Member will be responsible for a per visit utilization fee of $30 to be
collected at the time of service.
• Members choosing the Monthly Membership Plan will be responsible for
Dues of $55 per month, $100/month for a two-person plan, $140/month for
a three-person plan, or $185/month for a four-person plan. Should there
be any additional dependents beyond the four-person plan, a fee of $40
per month will apply thereafter.
• Members choosing the Yearly Membership Plan will be responsible for
Dues of $599 per year, $1,099/month for a two-person plan, $1,499/month
for a three-person plan, or $1,999/month for a four-person plan. Should
there be any additional dependents beyond the four-person plan, a fee of
$480 per year will apply thereafter.
• Primary Member understands that they are responsible for payment of
their Dues as well as those of all other Family Members covered under
their Membership.
5. AUTOMATIC PAYMENTS:
• Member understands their Membership Dues are paid by automatic
withdrawal/charge.
• Member herein:
• Grants Davam Urgent Care permission to make such withdraws/charges.
• Agrees to provide Davam Urgent Care/Davam Family Medicine with
accurate and valid account information to perform such
withdraws/charges.
• Agrees to provide the identified entity (Bank, Savings Institution, etc.)
from which these withdraws/charges are to be made with all notice and
documentation that may be required.
6. TREATMENT INCLUDED IN MEMBERSHIP:
• Only those healthcare services then provided by Davam Urgent
Care/Davam Family Medicine in the normal course of business are subject
to the sole discretion of Davam Urgent Care/Davam Family Medicine.
• Treatment that is currently included within the Membership:
• Urgent care office visits, laboratory tests performed on site at
Davam Urgent Care (i.e. CBC, CMP, urinalysis, pregnancy test,
strep screens, cardiac enzyme, flu screens), x-rays, EKG’s, IV fluid
administration, nebulizer treatment, simple laceration repair,
injections, injectable medicines, tetanus immunization, discounted
flu vaccines when available, splinting and office procedures that are
then provided in our clinics.
7. TREATMENT EXCLUDED FROM MEMBERSHIP:
• Member understands Davam Urgent Care/Davam Family Medicine:
• Is a provider of non-emergent episodic and ongoing medical care.
• Provides services within a certain scope of healthcare and there
are services Davam Urgent Care does not provide.
• The list below includes most, but possibly not all, of the services
that are not included under the terms of their membership.
• Excluded services include, but are not limited to:
• Prescriptions
• Life-threatening events such as gunshot wounds, heart attacks,
serious infections, hospitalizations, and treatment with other
doctors or providers at another facility that is not Davam Urgent
Care/Davam Family Medicine.
• Special diagnostic studies such as outside labs, ultrasounds,
doppler studies, mammograms, MRIs, CAT scans, PET scans, and
other special X-rays that are not provided at Davam Urgent Care.
• Hepatitis immunizations, and any other immunizations not listed in
“Included Services”.
• Durable medical equipment (DME), physical and occupational
therapy, chronic pain management, psychiatric emergency
management, outpatient pharmacy, work injuries, and other
workers’ compensation services.
• Weight management, and any emergency care that the attending
physician believes should, in the best interest of the Member, be
provided by another Facility or Provider.
8. MEMBER USAGE:
• Certain situations may require further medical attention including but not
limited to medical prescriptions, referral to a specialist, referral to a
hospital, or treatment that is not included in your Membership.
• The cost of any charges associated with these additional services are
NOT covered by this Membership. Any such costs are the sole
responsibility of the Member.
• Davam Urgent Care/Davam Family Medicine reserves the right, in its sole
discretion, to cancel Membership for inappropriate use of services,
including but not limited to requests for services that are not then currently
provided at Davam Urgent Care/Davam Family Medicine.
• The attending physician will determine the appropriateness of the
Members’ visit.
9. TERMINATION OF MEMBERSHIP:
Membership may be terminated by any of the following methods:
• Member terminating account online. Monthly Membership Plans will be
subject to a $199 cancellation fee should plan be terminated within 12
months of activation.
• Membership plans with dependents will be subject to a $199 cancellation
fee per member should plan be terminated within 12 months of activation.
• Members of the Yearly Membership plan will not be subject to any
cancellation fee, as it is a one-time annual charge.
• Member fails to allow Davam Urgent Care/Davam Family Medicine the
authority to withdraw/charge the monthly fees.
• Davam Urgent Care/Davam Family Medicine has the right to cancel
Memberships at any time for any reason. If they choose to terminate the
Member’s Membership. Effective date will be the same as day of
termination.
• Falsification of identification or failure to pay will result in immediate
termination of Membership, assessment of utilization fee, full price
charges for any services rendered, and the full pursuit of the legal rights
held by Davam Urgent Care/Davam Family Medicine.
10. REACTIVATING A CANCELLED MEMBERSHIP:
• A canceled Member, in good standing with Davam Urgent Care/Davam
Family Medicine, may reactivate Membership at any time but will be
charged the same fees and Dues that apply to new membership.
• Davam Urgent Care/Davam Family Medicine reserves the right to deny
the renewal privileges of any Membership terminated in accordance with
the Terms and Conditions of Membership.
11. CHANGES IN PERSONAL INFORMATION:
• Members must inform Davam Urgent Care/Davam Family Medicine in a
timely manner of all changes to billing information.
• If Davam Urgent Care/Davam Family Medicine is not able to receive
payment of monthly dues because of changes in billing information not
being provided, account will be placed on hold until past balance of Dues
and correct billing information is provided to Davam Urgent Care/Davam
Family Medicine.
Accounts that are on hold will be terminated after 3 months of inactivity.
12. WAIVER:
The failure by Davam Urgent Care/Davam Family Medicine to exercise or
enforce any of the terms or conditions of this Terms and Conditions of
Membership is not to be deemed a waiver of Davam Urgent Care/Davam Family
Medicine’s rights to enforce each and every term hereof. The failure by Davam
Urgent Care/Davam Family Medicine to insist upon strict performance of any of
the terms or conditions of the Terms and Conditions of Membership will not be
deemed a waiver of any subsequent breach or default in the terms or provisions
herein.
13. ASSIGNMENT:
This Membership may not be re-assigned or transferred.
14. LIMITATION OF ACTIONS:
Any legal action against Davam Urgent Care/Davam Family Medicine for default
of its obligations to the Member must be commenced within one (1) year from the
date the default was or should have been, discovered.
15. FORCE MAJEURE:
Davam Urgent Care/Davam Family Medicine is not liable for any delay or failure of
performance caused by strikes, insurrection, war, fire, electrical failure, brownouts,
disruption of transmission lines, government acts or regulations, acts of third parties, or
any cause not within the control of Davam Urgent Care/Davam Family Medicine.
16. GOVERNING LAW:
The validity, construction, and interpretation of this Agreement and the rights and
duties of the parties hereto will be governed by the laws of Texas without regard
to choice of law principles.
17. VENUE:
The exclusive venue for any litigation arising out of, or related to, these Terms
and Conditions of Membership will be Harris and Montgomery County and the
state of Texas.
18. ADR CLAUSE:
If a dispute arises from or relates to these Terms and Conditions or the breach
thereof, and if the dispute cannot be settled through direct discussions, the
Member and Davam Urgent Care/Davam Family Medicine agree to endeavor
first to settle the dispute by mediation before resorting to arbitration. The Member
and Davam Urgent Care/Davam Family Medicine further agree that any
unresolved controversy or claim arising out of or relating to these Terms and
Conditions, or breach thereof, shall be settled by arbitration.
19. ENTIRE AGREEMENT:
These Terms and Conditions of Membership constitute the entire agreement
between the parties relating to the specific subject matter hereof. There are no
terms, obligations, covenants, representatives, statements, or conditions other
than those contained herein. No variation or modification of these Terms and
Conditions of Membership or waiver of any of the terms or conditions hereof,
except that Davam Urgent Care/Davam Family Medicine may add or cease
medical services it provides and included under the terms hereof, at its sole
discretion will be deemed valid unless in writing and signed by both parties.
20. UNENFORCEABLE TERMS:
If any provision of these Terms and Conditions of Membership is held invalid,
illegal, or unenforceable, these Terms and Conditions of Membership will be
interpreted as if such provision, to the extent the same has been held invalid,
illegal, or unenforceable, had never been contained herein.
21. SUCCESSORS:
These Terms and Conditions of Membership shall be binding upon and inure to
the benefit of the parties hereto and their respective heirs, successors, or
executors.
22. NOTICES:
Any notice required or allowed to be given shall be addressed in a timely manner
to the other party at the address set forth immediately below or to such other
address as either party may instruct the other party in writing in accordance with
this Section 21.
Davam Urgent Care
Medical Membership Program
6022 Farm to Market RD 1488
Magnolia, TX 77354