Klein Dental Arts Membership Club Terms and Conditions

Dental Membership Club Agreement

The following terms and conditions govern your enrollment and participation in a dental membership club (the “Club”) offered by Klein Dental Arts, an independent dentist or dental practice (the “Dental Practice”). To enroll you in, operate, and administer your membership in the Club, the Dental Practice will use a cloud-based software platform and related software services (the “Software”) provided through itrac LLC (“illumitrac”).

By using the Software to enroll in the Club, you will be entering into a binding agreement (the “Agreement”) between you and the Dental Practice, including acknowledging and agreeing to the following terms and conditions. Do not use the Software to enroll in the Club if you do not wish to enter into the Agreement and be bound by the terms and conditions set forth in this document.

By using the Software to enroll in the Club, you hereby enter into this Agreement under which you agree to, understand, and acknowledge the following:

Non-Insurance Disclaimer

THE CLUB THAT YOU ARE CHOOSING TO ENROLL IN IS NOT AN INSURANCE PLAN AND IS NOT INTENDED TO REPLACE DENTAL INSURANCE. THE CLUB IS NOT A QUALIFIED HEALTH PLAN UNDER THE AFFORDABLE CARE ACT NOR IS IT A MEDICARE PRESCRIPTION DRUG PLAN. THE MEMBERSHIP FEE IS NOT AN INSURANCE PREMIUM. NEITHER THE CLUB, THE DENTAL PRACTICE, NOR ILLUMITRAC ARE LICENSED INSURERS, HEALTH MAINTENANCE ORGANIZATIONS, OR OTHER UNDERWRITERS OF HEALTH CARE SERVICES. ILLUMITRAC DOES NOT OFFER OR PROVIDE A DENTAL MEMBERSHIP CLUB OR PROVIDE OR PAY FOR ANY DENTAL SERVICES. DENTAL MEMBERSHIP CLUBS ARE DIRECT PAYMENT ARRANGEMENTS BETWEEN MEMBERS AND THE DENTAL PRACTICE FOR SELECTED SERVICES AND CARE PROVIDED BY THE DENTAL PRACTICE. PATIENTS ARE ENCOURAGED TO CONSULT WITH THEIR HEALTH/DENTAL INSURANCE PLANS BEFORE ENTERING INTO THIS AGREEMENT.

General Information about the Club

A dental membership club is a membership program for specified dental services to be provided by the Dental Practice. The Club provides a set of specified dental services to patients, as described in the offering information and the enrollment/sign-up documentation, with no out-of-pocket fees other than the membership fee, which are referred to herein as the “Services.” Other member benefits may be offered by the Dental Practice solely at the Dental Practice’s discretion. The Dental Practice may offer additional services outside of the Services at an extra cost, as determined by the Dental Practice.
The Dental Practice, not illumitrac, operates and administers the Club.
To use the Software, you must enter into a Patient Software License Agreement with illumitrac.
illumitrac does not determine what Services are provided under the Club, the amount of the membership fee, or any other member benefits.
The Club is not a dental insurance plan; instead, it is a program offered to you through the Dental Practice, and is between you, any other individuals that you enroll in the Club, and the Dental Practice.
Your selection of a dental practice is your responsibility and is not based on any representations made. illumitrac does not guarantee that any particular dental practice will continue to offer a dental membership club for any period of time.
Your participation in the Club will not be terminated solely on the basis of your health status.

Enrollment in the Club

By enrolling in the Club, you agree that you are voluntarily becoming a member of a dental membership club and understand that your membership is non-transferrable.
By enrolling in the Club and paying the required membership fee, you and each person you enroll become eligible to receive the Services from the Dental Practice offering the Club.
You will not be charged separately by the Dental Practice for the Services so long as you have paid and are current with any membership fee payments.
You will be charged directly by the Dental Practice for any non-Services provided by the Dental Practice. You will also be charged directly by the Dental Practice for any further treatment required to treat a dental or health condition discovered during the provision of any Services. Any late fees or missed-appointment fees that the Dental Practice may charge will still apply and will be your responsibility.
You may not combine a dental membership club, including your membership in the Club, with any active discount, discount plan, or dental insurance plan (including Medicare, Medicaid, other forms of government insurance or assistance, and/or any private insurance plan or policy).
To enroll in the Club using the Software, you must provide the required information. You represent that all information you provide during the account sign-up process and at any time thereafter, for yourself and for those that you enroll, will be true, accurate, complete, and current, and that you will promptly update any of the requested information as necessary such that it is, at all times, true, accurate, complete, and current.
You represent that for each person you enroll in the Club under your membership, you have all legal authority to enroll such person, and you agree that you will be responsible for all costs and expenses incurred, including all applicable membership fees.
You agree that you will receive all communication regarding your membership account via email.
Use of the Software requires compatible devices, internet access, and certain software; and may be affected by the performance of these requirements. You agree that meeting these requirements, which may change from time to time, is your responsibility. illumitrac does not represent or guarantee you will be able to access the Software at all times.

Personal Information and Privacy Policy

To enroll in the Club, you will be required to provide certain personal information. You are responsible for maintaining the confidentiality and security of your information and for all activities that occur on or through the Club, including password and other login information.
By enrolling in the Club using the Software, you confirm that you have reviewed and consent to the terms of the illumitrac privacy policy for yourself and those you enroll in the Club.

Membership Fees, Term, Cancellations, and Refunds

The Club will use the Software to process membership fees.
Your Club membership will operate on a month-to-month basis and includes an auto renewal feature. You agree to pay the one-time member activation fee at the time of enrollment. This one-time activation fee includes your first month’s Club membership fees. You understand that you are agreeing to make regular monthly membership fee payments in order to receive Services as a Club member. The Club membership runs month-to-month. Club members can cancel their membership at any time.
Your monthly membership will automatically renew on the first of each month following your effective date unless you opt out and affirmatively discontinue or cancel your participation in the Club.
You agree that illumitrac, using the Software and on behalf of the Club, may process your payment for all membership fees associated with the Club that you choose using the payment method that you have provided as part of your enrollment. By enrolling in the Club and providing your payment information, you, the member, are authorizing illumitrac, using the Software and on behalf of the Club, to bill your credit card or checking account for the applicable Club membership fees for the initial term and any renewal term(s) at the plan level rate that you have selected based on the number of individuals you have enrolled in the Club at the time of renewal.
You will have a 30-day cancellation period commencing on the date of your initial enrollment in the Club, provided that no Services have been rendered during that period.
Your Club membership may be terminated by the Dental Practice, directly or by illumitrac, without prior notice at any time and for any reason, including non-payment of membership fees. In the event that your Club membership is terminated for any reason other than non-payment of membership fees, you will receive a pro-rata refund of the membership fees that you have paid.
You may cancel your Club membership at any time. You may receive a refund of any membership fees paid for the current term if the cancellation is received within 30 days of the start of the current term, and (ii) no Services or products have been provided during the current term to any member(s) enrolled in the Club. Written notice of cancellation is deemed given to the Dental Practice c/o illumitrac when (i) sent via email to undefined, or (ii) deposited in a mailbox, properly addressed, and postage prepaid to illumitrac at 4062 Peachtree Rd, #A-457, Brookhaven, GA 30319. Such refund provisions will be processed in accordance with the requirements of the applicable state laws. Arkansas, Florida, Louisiana, and Washington residents may be entitled to a full refund of membership fees paid for the current term, if the cancellation request is received within 30 days of the start of the current term, regardless of whether any Services or products have been provided to any member(s) under the Plan during the current term. Residents of California, Florida, and Oklahoma who cancel after the first 30 days of the term may be entitled to a pro-rata refund. All refunds will be processed by the Dental Practice.
The membership fees may be changed by the Dental Practice at any time, upon expiration of the current term with notice provided no less than 60 days before the new rate becomes effective, or such longer period as may be required under applicable law. It will be assumed that you have agreed to the change in fees unless you cancel your membership prior to the end of the current term.

State Notices

ALABAMA NOTICE: This Agreement does not constitute health insurance of the laws of this state. 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 111-148, for failing to obtain insurance. 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. Payments made by a patient for services rendered under a physician agreement may not count toward the patient's health insurance deductibles and maximum out-of-pocket expenses. A patient is encouraged to consult with the patient's health insurance plans before entering into the Agreement and receiving care.
ARIZONA NOTICE: The organization facilitating the direct primary care agreement is not an insurance company and the direct primary care company guidelines and agreement are not an insurance policy. Participation in the direct primary care agreement or a subscription to any of its documents should not be considered to be a health insurance policy. Regardless of whether you receive treatment for health care issues through the direct primary care agreement, you are always personally responsible for paying any additional health care expenses you may incur. If you have health insurance, it may include, at no additional charge, some of the preventive services that are also available under this direct primary care agreement. The primary care provider may not bill your health insurance for primary care services provided under this direct primary care agreement.
CALIFORNIA NOTICE: You waive your rights under California Civil Code Section 1542. Your understand the meaning of California Civil Code Section 1542, which reads as follows: “A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.”
COLORADO NOTICE: This Agreement is not health insurance and does not meet any individual health benefit plan that may be required by federal law. Patients are not entitled to health insurance protection for consumers under Colorado revised statutes title 10.
FLORIDA NOTICE: This Agreement is not health insurance and the primary care provider will not file any claims against the patient's health insurance policy or plan for reimbursement of any primary 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, 26 U.S.C. S. 5000a. This Agreement is not workers' compensation insurance and does not replace an employer's obligations under chapter 440.
IDAHO NOTICE: This Agreement does not provide health insurance coverage, including the minimal essential coverage required by applicable federal law. It provides only the services described herein. It is recommended that health care insurance be obtained to cover medical services not provided for under this direct primary agreement.
KANSAS NOTICE: This medical retainer agreement does not constitute insurance, is not a medical plan that provides health insurance coverage for purposes of the federal patient protection and affordable care act and covers only limited, routine health care services as designated in this Agreement.
MISSISSIPPI NOTICE: This Agreement is not health insurance. Standing alone, the Agreement does not satisfy the health benefit requirements as established in the federal affordable care act. Without adequate insurance coverage in addition to this Agreement, the patient may be subject to fines and penalties associated with the federal affordable care act.
NEBRASKA NOTICE: This Agreement does not constitute insurance and is not a medical plan that provides health insurance coverage for purposes of any federal mandates. This direct primary care agreement only provides for the primary care services described in the Agreement. It is recommended that insurance be obtained to cover medical services not provided for under this direct primary care agreement. You are always personally responsible for the payment of any additional medical expenses you may incur.
OREGON NOTICE: This Agreement is not insurance, and the Dental Practice does not provide insurance. The Dental Practice provides only the limited scope of primary care services specified in this Agreement. Patients must pay for all services not specified in this Agreement.
TENNESSEE NOTICE: This Agreement does not constitute health insurance under the laws of this state. An uninsured patient that enters into a direct medical care agreement may be subject to tax penalties under the patient protection and affordable care act, Public Law 111-148, for failing to obtain insurance. Patients insured by health insurance plans that are compliant with the patient protection and affordable care act already have coverage for certain preventative care benefits at no cost to the patient. Payments made by a patient for services rendered under a direct medical care agreement may not count towards the patient's health deductibles and maximum out-of-pocket expenses. Patients are encouraged to consult with their health insurance plans before entering into the Agreement and receiving care. A direct medical care provider who breaches this Agreement may be liable for damages and subject to discipline by the appropriate licensing board.
VIRGINIA NOTICE: This Agreement does not provide comprehensive health insurance coverage. It provides only the provision of primary care as specifically described in this Agreement.
WASHINGTON NOTICE: THIS AGREEMENT DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE. IT PROVIDES ONLY THE FOLLOWING HEALTH CARE SERVICES: Adult D1110, D0120, D0274, D0140, D0220; Adult D1110, D0120, D0274, D0140, D0220; Perio D4910, D0120, D0274, D0140, D0220; Perio D4910, D0120, D0274, D0140, D0220; Child D1120, D0120, D0272, D1208, D0140, D0220; Child D1120, D0120, D0272, D1208, D0140, D0220. INFORMATION ABOUT PAYMENTS MADE AND SERVICES PROVIDED TO PATIENTS IS AVAILABLE UPON REQUEST. REFUNDS WILL BE PROVIDED FOR PATIENTS WHOSE SUBSCRIPTION PAYMENTS EXCEED THE VALUE OF SERVICES RENDERED. FEES MAY BE INCREASED ANNUALLY WITH 60 DAYS’ NOTICE. PATIENTS ARE ENCOURAGED TO OBTAIN AND MAINTAIN INSURANCE FOR SERVICES NOT COVERED UNDER THIS AGREEMENT. THE DENTAL PRACTICE WILL NOT BILL A CARRIER FOR SERVICES COVERED UNDER THIS AGREEMENT. PATIENTS HAVE FINANCIAL RIGHTS AND Klein Dental Arts MAY NOT DECLINE TO ACCEPT NEW PATIENTS OR DISCONTINUE CARE TO EXISTING PATIENTS SOLELY BECAUSE OF THE PATIENT'S HEALTH STATUS. PATIENTS ALSO HAVE RESPONSIBILITIES TO THE DENTAL PRACTICE, AND THE DENTAL PRACTICE MAY DISCONTINUE CARE FOR PATIENTS IF: (A) THE PATIENT FAILS TO PAY THE FEE UNDER THE TERMS REQUIRED BY THIS 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 THE DENTAL PRACTICE; OR (E) THE DENTAL PRACTICE DISCONTINUES OPERATION AS A DIRECT PRACTICE. THE CONTACT INFORMATION FOR THE OFFICE OF THE INSURANCE COMMISSIONER OF WASHINGTON STATE IS AS FOLLOWS. ADDRESS: 302 SID SNYDER AVE. SW, SUITE 200, OLYMPIA, WA 98501. TELEPHONE: 360-725-7000. ADDITIONAL CONTACT INFORMATION MAY BE AVAILABLE AT HTTPS://WWW.INSURANCE.WA.GOV/CONNECT-US OR CALL 800-565-6900.