CAPELLA PROGRAM MEMBER TERMS & CONDITIONS
This Membership Agreement (“Agreement”) is entered into by and between
The Capella Group, Inc. (“Capella”) and members of Capella’s discount
medical program (“Members”). All Members subscribing to Capella’s
discount medical program (“Capella Program”) should read the terms of
this Agreement carefully and communicate any questions that arise to a Capella Member
Services Representative available by telephone Monday – Thursday, 7 a.m. to
6 p.m. and Friday, 7 a.m. to 3 p.m., Central Time at 1-888-411-3888.
The Capella Program is NOT health insurance or a health insurance policy.
It is a discount medical plan. The Capella Program provides discounts only at certain
health care providers for healthcare services. Member is obligated to pay for all
healthcare services but will receive a discount from those health care providers
participating in the provider networks which have contracted with THE CAPELLA GROUP.
Neither Capella nor the Capella Program makes payments to providers for medical
services.
1. Definitions. As used in this Agreement and the Description of
Services and Disclosure Form (“DOS/DF”), the following terms shall have
the meaning assigned to each in this Section 1:
“Network” shall mean an entity which contracts with health care providers
for the availability of discounted health care services to Capella Program Members.
“Family member” shall mean those individuals who by relationship, residence
or support qualify as “dependants” as defined by the Internal Revenue
Code and the United States Internal Revenue Service.
“Participating provider” shall mean a health care provider who has agreed
through his or her contract with a network (as defined above) to make discounted
services available to Capella Program Members.
“Dependants” shall mean those individuals who by relationship, residence
or support qualify as “dependants” as defined by the Internal Revenue
Code and the United States Internal Revenue Service.
“Chiropractic” shall mean that branch of the healing arts focused on
the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system.
“Ancillary services” shall mean laboratory, radiologic, and/or other
diagnostic services incident to treatment by a physician and/or hospital.
[“Service Area” definition to come.]
2. Description of Program's Features. Each Member is entitled to
receive discounts on specified services (collectively, “Services”) when
using a participating provider as set forth in the Description of Services and Disclosure
Form (“DOS/DF”). Members are entitled to receive certain Services from
participating providers at predetermined amounts and certain other Services for
a percentage discount off the participating provider's normal retail prices for
such Services. Other terms and conditions regarding Services, the Services eligible
for discounts, and the discounted fees for the Services included are listed in the
DOS/DF and are subject to change, modification, or substitution by Capella at any
time provided that Capella shall notify the Member of any decrease in benefits under
the Capella Program at least thirty (30) days before such decrease becomes effective.
Fees for Services vary by region. In order to receive Services at the discounted
rate, the Member must present his/her Membership ID Card to the provider before
Services are rendered. The Member must pay the provider directly at the time of
Service unless otherwise agreed upon between the provider and Member. If prompt
payment to the provider is not made or arrangements for payment are not promptly
made, the provider may rescind the discount. The discount features of the
Capella Program may not be available for cosmetic procedures.
3. Membership Term. On the date following Capella’s
acceptance of a prospective Member’s application for membership and Capella’s
receipt of the initial fee for membership in the Capella Program (“Membership
Fee”) and any applicable enrollment or processing fee, the prospective Member
shall become a Member and shall be entitled to all Services for the term (“Membership
Term”) the Member selects at the time of activation and for so long as the
Member continues to pay required Membership Fees and otherwise complies with the
terms of this Agreement. Members may select from Membership Terms offered
at the time of activation which may include monthly, semi-annual or annual options.
4. Renewal Provisions. At the conclusion of the Membership Term,
membership in the Capella Program will be renewed automatically unless the Member
notifies Capella by providing written notification to Capella before the beginning
of the new Membership Term, that he/she wishes to cancel his/her membership in the
Capella Program. If the Member either fails to notify Capella of his/her election
not to continue the membership or fails to return the membership ID Card(s) as required
herein, membership in the Capella Program will be renewed automatically and the
Membership Fee for an additional term will be charged against the Member's credit
card or by debit to the Member's checking account, depending on the payment option
authorized by the Member. Should a Member have any questions concerning the Capella
Program, or the continuation or cancellation of membership, he/she should call a
Member Services Representative at the number on his/her membership ID Card.
5. Prepayment Fees. Payment of the initial Membership Fee and any
renewal Membership Fee (see page 1 of the DOS/DF) will be made automatically by
a charge against the Member's credit card or by a debit to the Member's checking
account (depending on the payment option authorized by the Member) for the full
amount of the Membership Fee for the Membership Term. A Member may change the mode
of payment by contacting Member Services toll-free at the number listed on his/her
membership ID card or by writing to the address provided in Paragraph 15 below.
A Member who chooses to pay Membership Fees by a direct charge against the Member's
credit card or by a direct debit to the Member's checking account statement may
not receive notice from Capella of a subscription payment due; rather, the Member
will be notified of the billing in his/her credit card or checking account statement.
Each Member hereby authorizes Capella to bill and receive payment for the Membership
Fee as set forth in this Agreement. Capella reserves the right to increase the Membership
Fee for a future Membership Term but shall not increase the Membership Fee for a
future Membership Term except after a period of at least thirty (30) days after
the postage paid notice of such increase has been mailed to the Member at the Member’s
most current address of record with Capella.
6. Other Charges. In addition to the Membership Fees discussed
herein, the Member is subject to charges by providers for any services received
by the Member. While Capella is NOT responsible for paying charges for services
received by its Members, Capella does pay a fee to provider networks for access
to providers who are then participating in the provider networks, but in no event
will any Member be liable for any charge owed by Capella to a provider or provider
network.
7. Choice of Physicians and Providers. Discounts are available
from any participating provider. A list of participating providers is available
before purchase and upon request by calling Capella toll-free at the number listed
on the membership ID card or by visiting the website listed on the membership ID
card.
LIABILITY OF SUBSCRIBER FOR PAYMENT: The Member is responsible
for paying providers and/or vendors for Services rendered at time of Service unless
otherwise agreed upon by the Member and provider or vendor.
8. Termination of Benefits. Capella may terminate a Member’s
membership in the Capella Program for non-payment of Membership Fees due.
In the case of such a termination by Capella, the Member’s right to receive
applicable discounts shall cease no earlier than fifteen (15) days after Capella
has sent by mail a written notice to the Member indicating that it has not received
payment and that benefits will cease. In the case of such a termination, the
Member’s membership will be reinstated if Capella receives the amount owed
on or before the due date of the next periodic payment. However, if such payment
is received more than fifteen (15) days after issuance of the notice of cancellation,
Capella will refund such payment to the Member within twenty (20) business days
of its receipt, and the membership will not be reinstated.
If a Member is not satisfied with the Capella Program and wishes to terminate his/her
membership, the Member may cancel the membership for any reason and at any time
by notifying Capella in writing and by immediately returning his/her Membership
ID Card to Capella. Membership in the Capella Program will terminate at the
end of the Membership Term following the date on which Capella receives the notice
of cancellation. Notice of cancellation must be received by Capella before
the next billing cycle. If the Member cancels his/her membership within the first
thirty (30) days after the effective date, the Member will be reimbursed for all
periodic charges paid. The return of all such periodic charges will be made
within thirty (30) days of the cancellation date, and if all such periodic charges
have not been reimbursed within thirty (30) days of the cancellation date, interest
will be assessed against Capella as required by applicable law. If the billing
frequency is less than monthly (e.g. annually or semi-annually), the Member will
be provided a prorated refund of the Membership Fee paid for any unused portion
of the Membership Term remaining after the next monthly anniversary of the Member’s
activation. Any cancellation of membership in the Capella Program will not
affect any Services or discounts received by a canceling Member before the effective
date of the cancellation. IF A MEMBER CANCELS WITHIN THIRTY (30) DAYS OF THE
EFFECTIVE DATE, CAPELLA WILL REFUND THE INITIAL MEMBERSHIP FEE. THE ENROLLMENT
OR APPLICATION FEE IS NON-REFUNDABLE (EXCEPT WHERE PROHIBITED BY
LAW).
9. Eligibility. A prospective Member becomes a Member and may access
services on the date following Capella’s acceptance of a prospective Member’s
application for membership and Capella’s receipt of the fee for membership
in the Capella Program (“Membership Fee”) and any one-time applicable
enrollment or processing fee. The Member’s access to services shall continue
for so long as the Member continues to pay required Membership Fees and otherwise
complies with the terms of this Agreement.
In the event that Capella fails to receive a prospective Member’s payment
of the Membership Fee and any applicable enrollment or processing fee within fifteen
(15) days of its receipt of the prospective Member’s application for membership,
Capella will notify the prospective Member in writing that his/her enrollment has
been rejected for lack of payment. The notification will: (a) be dated, (b)
state the cause for rejection with specific reference to the clause of the Terms
& Conditions document giving rise to the rejection, (c) state that the cause
for rejection was not the prospective Member’s health status or requirements
for health care services, (d) state the time when rejection is effective, and (e)
inform the prospective Member that he/she may request that the Director of the Department
of Managed Health Care review the rejection if the prospective Member alleges that
the membership was rejected because of the prospective Member’s health status
or requirements for health care services.
Membership in the Capella Program and Member's rights or duties under this Agreement
may not be assigned or delegated without the prior express written consent of Capella.
Member agrees that he/she will use his/her Capella Program membership only for his/her
personal benefit or for the benefit of his/her dependents. ''Dependants'' are a
spouse or registered domestic partner, children up to the age of 25, parents in
the household over age 60 and any other individuals classified as dependants by
the Internal Revenue Code or the United States Internal Revenue Service. A Member's
violation of this provision and any fraud or deception committed in conjunction
with membership in the Capella Program may, at the discretion of Capella, result
in immediate termination of the membership. Dependents must be registered with Capella.
A Member may register Dependents by calling Member Services toll-free at the number
on his/her membership ID card.
10. Complaint Procedure. Any complaint regarding Capella Program
membership should be directed to Member Services at the toll-free number on the
ID Card or in writing to the address shown in Paragraph 15 below. Each complaint
will be acknowledged in writing within five (5) business days of its receipt.
After Capella has investigated the complaint, the Member will receive a letter disclosing
the results of that investigation no later than thirty (30) calendar days after
Capella’s receipt of the complaint.
11. Membership Payment/Billing. If a Member wishes to confirm whether
a discount is available for a particular Service through the Capella Program, or
wishes to confirm the current fee for a particular Service, he/she should call a
Member Services Representative at the toll-free number located on the membership
ID Card.
12. Membership Representations and Acknowledgments.
In return for the discounts and Services available under the Program, the Member
makes the following representations and acknowledgments:
(a) Member has read this Agreement carefully, understands the Capella Program, including
an understanding and acknowledgment that the Capella Program is NOT INSURANCE.
(b) Member may cancel his/her membership in the Capella Program at any time before
the conclusion of the Membership Term and will be entitled to a refund as set forth
in and subject to Paragraph 8 of this Agreement.
(c) Unless the Member cancels his/her membership in accordance with Paragraph 8
of this Agreement, the Program membership will be automatically renewed on the first
day following the conclusion of a Membership Term, and payment of the Membership
Fee for the new Membership Term will be made by a direct charge against the Member's
credit card or by a debit to his/her checking account.
(d) Member is responsible for paying providers and/or vendors for Services rendered
at time of Service unless otherwise agreed upon by Member and provider or vendor.
(e) Participating providers are entirely independent of Capella and its affiliates.
Capella, its affiliates and its contracted networks do not guarantee the quality
of services or products offered by individual providers and are not responsible
for the provision of or the failure to provide health care by any participating
provider. Capella does not practice medicine or in any manner interfere with
or participate in the provider-patient relationship. All health care decisions are
between the patient and provider. The selection of a participating provider is the
obligation and decision of the patient and is not based upon the credentialing or
any recommendation by Capella, except that all providers included on the list of
participating providers made available to the Member shall, at the time such list
is provided, be licensed and credentialed as required by applicable law.
(f) Neither Capella, its affiliates, nor any network accessed shall be liable for
any payment to a provider accessed under the Capella Program. Neither Capella,
its affiliates, nor any network accessed is an insurer, guarantor or underwriter
of the responsibility or liability of the Member for Member’s or Member’s
dependents’ medical care or any other goods or services provided to Member
or Member’s dependents.
(g) The Capella Program is NOT insurance, and it may not reduce deductibles, co-payments
or other out-of-pocket expenses for Services that are covered by insurance.
Additionally, the Capella Program may not be used to coordinate coverage with Medicare
or other government assistance programs.
13. Disclaimer of Warranties. Capella is not a merchant,
manufacturer, or a provider of the Services. CAPELLA DOES NOT GIVE ANY WARRANTY,
EXPRESS OR IMPLIED, AS TO DESCRIPTION, QUALITY, MERCHANTABILITY, FITNESS FOR ANY
PARTICULAR PURPOSE, PRODUCTIVENESS, OR ANY OTHER MATTER, FOR ANY SERVICES OR MERCHANDISE
PURCHASED OR RECEIVED BY A MEMBER FROM A PROVIDER OR VENDOR THROUGH HIS/HER MEMBERSHIP
IN THE PROGRAM. MEMBER ACKNOWLEDGES THAT HE/SHE IS NOT RELYING ON CAPELLA'S SKILL
OR JUDGMENT IN SELECTING A PROVIDER OR VENDOR FOR THE SERVICES AVAILABLE TO MEMBERS.
In the event any product or Service purchased or received by a Member is canceled,
modified, defective, or otherwise unsatisfactory to the Member, the Member will
look solely to the provider, seller, merchant, vendor or manufacturer of the product
or Service for any repair, exchange, refund or satisfaction of any claim. Member
understands and agrees that any Service included in the Capella Program is subject
to availability and may be changed, terminated or removed from the Program at any
time, provided that Capella shall notify the Member of any decrease in benefits
under the Capella Program at least thirty (30) days before such decrease becomes
effective.
14. General Release. Each Member, for himself/herself, and on behalf
of any Dependent as defined herein who uses the Services under the Capella Program
membership (''Membership Participant''), hereby forever releases, acquits and discharges
each of Capella and its employees, officers, directors, agents and affiliates from
any and all liabilities, claims, demands, actions, and causes of action that such
Member, Membership Participant or Member's legal representative(s) may have by reason
of any damage or personal injury sustained as a result of or during the course of
the use of any service. The sole recourse available to a Member, Membership Participant
or Member's legal representative(s) against Capella will be cancellation of the
Capella Program membership and refund, if applicable, as provided in Paragraph 8.
This provision shall not apply, however, to Capella’s liability for the availability
and accessibility of services at advertised discounts, as provided in this Agreement
and the DOS/DF.
15. Notices. Any notice, consent, approval, complaint, request or other
written communication given or required under this Agreement must be sent by first
class mail, postage prepaid, or by an overnight delivery service such as FedEx or
United Parcel Service, and, if from Capella to the Member, at the address shown
in Capella’s records, or, if from the Member to Capella at:
The Capella Group, Inc.
ATTN: Member Services
4929 W. Royal Ln. Suite 200
Irving, TX 75063
16. Entire Agreement. This Agreement sets forth the entire agreement
and understanding between the parties with regard to Member's membership in the
Capella Program and constitutes a final complete and exclusive statement of the
terms of the agreement between the parties with respect to Member's membership in
the Capella Program. Any other representation, inducement, promise or agreement
shall be of no force or effect.
17. Validity; Binding Effect. The validity or
unenforceability of any term of this Agreement will in no way affect the validity
or enforceability of any other term of this Agreement. This Agreement will be binding
upon and inure to the benefit of the parties and their respective successors and
permitted assigns.
18. Governing Law. This Agreement will be governed and construed
in accordance with the laws of the State of California, and venue for any proceedings
shall be the State of California court closest to the member’s residence,
except as required otherwise by applicable law. Any controversy or claim arising
out of or relating to this Membership agreement shall be settled by voluntary arbitration
administered by the American Arbitration Association in accordance with its Commercial
Arbitration Rules (including Optional Rules for Emergency Measures of Protection),
and judgment on the award rendered by the arbitrator(s) may be entered in any court
having jurisdiction thereof.
19. Waiver of Breach. A waiver by Capella of a breach of any provision
of this Agreement will not be deemed a waiver by Capella of any other breach of
the same or different provision.
20. Public Policy Committee. Capella has established a Public Policy
Participation Committee (the “Committee”) to advise its Board of Directors
on how to assure the comfort, dignity and convenience of members. Members
who are interested in serving on the Committee should contact Member Services for
more information.