Direct Primary Care Medical Membership Agreement

Practice Name: Padre Island Members Health Primary

Address: 14725 S. Padre Island Drive, Suite #301, Corpus Christi, TX 78418

This Direct Primary Care Medical Membership Agreement (“Agreement”) is entered into by and between Padre Island Members Health Primary (“Practice”) and the undersigned patient (“Patient”).

1. Scope of Services

The Practice provides direct primary care (“DPC”) services as defined under Texas law. These services include, but are not limited to:

Preventive care, health promotion, and patient counseling.

Routine and general primary care services.

Screening, diagnosis, and management of acute and chronic medical conditions.

Office and telehealth visits (telephone and video).

Laboratory and radiology orders with review and interpretation.

Minor procedures (see Section 4).

Important: This Agreement does not provide comprehensive health insurance and is not regulated by the Texas Department of Insurance.

2. Membership Benefits

Patients enrolled in the Membership Program receive:

Access to the Practice’s secure health app for communication, records, prescription requests, and scheduling.

No co-pays or deductibles. Services are not billed to insurance.

One (1) annual physical examination and up to ten (10) routine visits per year.

Direct access to the care team via secure messaging, phone, or video.

Priority scheduling for urgent needs (additional fees may apply).

The ability to cancel membership at any time with written notice.

Membership does not cover hospital care, emergency room services, surgery, prenatal/obstetrical care, cosmetic services, or specialist visits.

3. Membership Fees

Monthly Membership Fee (auto-billed via credit/debit card or ACH):

Under 18 years: $100/month

Ages 18–54: $150/month

Ages 65+: $175/month

Enrollment Fee: $200 per individual or $350 per family.

Additional Fees:

House calls & urgent care (members): $150/visit

Procedures not included in membership: see Section 4

Non-members: $250 urgent care visit (includes 1 follow-up within 30 days) / $150 physical exam

The Practice reserves the right to adjust fees annually with notice to patients.

4. Procedures (Available at Additional Cost)

Osteopathic Manipulative Treatment

Laceration repair

Cryotherapy (wart removal)

Skin biopsies, mole & skin tag removal

Pap smears & IUD management

Wound care, abscess drainage & packing

Foreign body removal (skin, ear, eye, etc.)

Earwax removal

Ingrown toenail treatment/removal

5. Medicare and Medicaid

The Practice has opted out of Medicare effective January 1, 2016. Patients may not submit claims to Medicare for reimbursement of fees paid under this Agreement.

Patients eligible for Medicare acknowledge and accept full financial responsibility for all services provided by the Practice.

Medicaid patients may elect to be treated on a private-pay basis. No claims will be filed to Medicaid.

6. Term & Termination

Either party may terminate this Agreement with 30 days’ written notice.

No refunds are issued for monthly fees already charged.

The Practice may terminate this Agreement immediately if the Patient fails to pay fees or violates Practice policies.

Re-enrollment after termination may require a $300 reinstatement fee and is subject to Practice discretion.

7. Legal Notices

This Agreement is not health insurance and does not satisfy any federal or state insurance mandates.

Patients are encouraged to maintain separate health insurance for services not provided under this Agreement.

The Practice complies with Texas House Bill 1945 (84th Legislative Session), establishing that direct primary care services are not subject to regulation as insurance.

8. Governing Law

This Agreement is governed by the laws of the State of Texas. If any provision is deemed invalid, the remaining provisions remain enforceable.

9. Signatures

By signing below, Patient acknowledges understanding and acceptance of the terms of this Agreement.

Practice Representative:

Signature: ___________________________

Printed Name: _______________________________

Date: __________________________

Patient/Responsible Party:

Signature: ___________________________

Printed Name: _________________________________

Date: __________________________