PeopleOne Health
Patient Agreement & Disclosure Statement
Service Relationship and Scope
Member Agreement for Direct Primary Care Services
By executing this Agreement, Member enters into a direct primary care services relationship with PeopleOne Health, Inc. and its affiliated entities, including PeopleOne Health Florida, LLC and PeopleOne Health Medical Group, PA (collectively, "PeopleOne Health"). Member also authorizes PeopleOne Health to coordinate care through its network of independent Care Partners, which are separate healthcare providers that PeopleOne Health may contract with to deliver additional services outside of direct primary care ("Care Partners").
Service Scope and Limitations
PeopleOne Health provides direct primary care services as defined in applicable state statutes, including but not limited to: routine primary care consultations, basic diagnostic services, care coordination, health coaching, and wellness programs as detailed in PeopleOne Health's standard services agreement available at [website]. Services are delivered through PeopleOne Health clinics and via telehealth platforms accessible nationwide.
Care Partner Services Disclaimer
Member acknowledges that certain services may be provided by independent Care Partners under separate contract with PeopleOne Health. Care Partners are independent healthcare providers, separate from PeopleOne Health entities, who may provide additional services outside of direct primary care. PeopleOne Health acts as a coordinator and facilitator of these services but does not assume liability for the independent medical judgments, acts, or omissions of Care Partners. Each Care Partner maintains independent responsibility for their professional services and carries appropriate professional liability coverage.
Insurance and Coverage Disclaimer
This Agreement does not provide comprehensive health insurance coverage nor is it a contract of insurance. Services do not represent minimum essential coverage under the Affordable Care Act. Member remains responsible for maintaining appropriate health insurance coverage for services not included in this Agreement.
Payment Structure and Authorization
Flexible Payment Arrangements
PeopleOne Health offers flexible payment structures to accommodate both employer-sponsored and individual direct membership arrangements:
a) Employer/Association Payment: For employer-sponsored members, fees are paid directly by the sponsoring employer or association according to separate agreements between PeopleOne Health and such entities.
b) Individual Direct Payment: For individual members, fees are paid directly by Member according to the payment terms specified in Member's enrollment materials.
c) Combination Arrangements: PeopleOne Health may, in its discretion, establish combination payment arrangements where costs are shared between employers and individual members.
Credit Card Payment Authorization (Individual Members)
For Member-paid services, Member authorizes PeopleOne Health to charge the credit card or bank account provided during enrollment for all applicable fees. Member represents that they are authorized to use the designated payment method and agrees to maintain current payment information.
Billing Cycles and Payment Terms
Initial Payment: Member authorizes a 60-day upfront payment upon enrollment
Ongoing Billing: Following the initial period, Member will be billed on 30-day cycles
Automatic Renewal: Payment authorization continues until terminated according to this Agreement
Payment Processing: All payments are processed through PCI DSS-compliant payment processors
Variable Pricing and Revision Rights
PeopleOne Health reserves the right to establish variable pricing for different membership arrangements, employer groups, and service levels. PeopleOne Health may revise pricing with 30 days' written notice to affected Members. Pricing changes will not affect prepaid periods.
Credit Card Payment Failures and Account Management
Declined Payment Notification: If a scheduled payment is declined, PeopleOne Health will notify Member via email and/or phone within 2 business days using the contact information on file. Member is responsible for maintaining current contact information.
Grace Period and Retry Attempts: Member will have a 10-day grace period from the date of notification to resolve payment issues. PeopleOne Health may, at its discretion, attempt to process the declined payment up to 2 additional times during this grace period.
During any grace period or account suspension, PeopleOne Health will continue to provide:
Emergency and urgent care services as medically necessary
Prescription refills for ongoing chronic conditions for up to 30 days
Completion of active treatment episodes already in progress
Care coordination for referrals and ongoing specialist care
PeopleOne Health reserves the right to limit non-urgent services during this period.
Account Suspension: If payment issues are not resolved within the 10-day grace period, Member's account will be suspended, and access to services will be temporarily discontinued. Member will be notified of account suspension via email and certified mail.
Reinstatement Requirements: To reinstate services after suspension, Member must: (1) resolve all outstanding payment issues; (2) pay any applicable late fees or administrative charges; and (3) provide updated payment information if necessary. PeopleOne Health may require immediate payment of current month's fees upon reinstatement.
Termination for Non-Payment: If payment issues remain unresolved for 30 days after account suspension, PeopleOne Health may terminate this Agreement immediately without additional notice. Member will remain responsible for all unpaid fees and any collection costs. During this final notice period, PeopleOne Health will continue to provide emergency care and assist with care transition to ensure continuity of care.
Updated Payment Method Requirements: Member agrees to promptly update payment information when credit cards expire, are cancelled, or when banking information changes. Failure to maintain current payment information may result in service interruption.
Member Enrollment and Dependent Authority
Primary Member Enrollment Authority
Member has the authority to enroll themselves and eligible household members/dependents under this Agreement, subject to the dependent definitions below.
Dependent Definitions
For Employer-Sponsored Members: Dependents are defined according to the sponsoring employer's benefit plan definitions and may include spouses, domestic partners, children, and other eligible family members as specified in the employer's agreement with PeopleOne Health.
For Individual Direct Members: Dependents include:
Legal spouse or domestic partner
Biological, adopted, or step-children up to age 18 (or up to age 26 if enrolled in full-time education)
Other dependents as specifically approved by PeopleOne Health
Enrollment Representations
By enrolling dependents, Member represents that:
They have legal authority to make healthcare decisions for enrolled dependents
All enrollment information provided is accurate and complete
They will promptly notify PeopleOne Health of changes in dependent eligibility
Communication and Contact Provisions
Contact Information Collection and Use
Member consents to PeopleOne Health's collection and use of personally identifiable information, including but not limited to: name, address, phone numbers, email addresses, emergency contacts, and demographic information necessary for service delivery and account management.
Service Communications Authorization
Member authorizes PeopleOne Health to communicate regarding:
Appointment scheduling and reminders
Treatment-related communications and care coordination
Account and billing information
Health and wellness program updates directly related to Member's care
Marketing and Outreach Communications
Member authorizes PeopleOne Health to contact Member regarding:
Additional services and membership upgrades
Health and wellness programs and resources
Educational materials and health information
Community events and member benefits
Member may opt-out of marketing communications at any time by contacting PeopleOne Health at the information provided below.
Third-Party Vendor Information Sharing
Member authorizes PeopleOne Health to share necessary contact and account information with third-party vendors who provide services on PeopleOne Health's behalf, including but not limited to: payment processors, IT service providers, marketing platforms, and Care Partners. All third-party vendors are bound by appropriate confidentiality and data protection agreements.
Termination and Refund Provisions
Member Termination Rights
Member may terminate this Agreement at any time and for any reason by providing 30 days' written notice to PeopleOne Health. Written notice may be provided via email to the address specified below or through Member's online portal.
Termination Effective Date
Regardless of when during a month the termination notice is provided, Member's coverage will terminate on the last day of the month in which the 30-day notice period expires. For example, if Member provides notice on January 15th, the 30-day notice period expires on February 14th, and coverage will terminate on February 28th (or 29th in leap years).
Re-enrollment Limitations
PeopleOne Health reserves the right to limit re-enrollment opportunities or modify pricing for members who re-enroll after voluntary termination. Members who terminate and subsequently seek to re-enroll may be subject to different pricing, waiting periods, or enrollment restrictions at PeopleOne Health's sole discretion. This provision is designed to ensure program integrity and fair access for all members.
Prepaid Fee Refunds
Since members pay one month in advance and termination is effective on the last day of the month following the 30-day notice period, no refunds will be provided for standard terminations as members receive services through their final paid month.
PeopleOne Health Termination Rights
PeopleOne Health may terminate this Agreement with 30 days' written notice for any reason, with termination effective on the last day of the month in which the notice period expires. PeopleOne Health may terminate immediately for cause including but not limited to: non-payment of fees, material breach of Agreement terms, or behavior that disrupts care delivery or endangers staff or other members. For immediate terminations due to cause, Member will receive a prorated refund of any prepaid fees for services not yet rendered, calculated from the effective termination date.
Member Obligations and Responsibilities
Active Participation in Care
Member agrees to actively participate in their healthcare by:
Disclosing all relevant health information to PeopleOne Health clinicians
Following agreed-upon treatment plans and recommendations
Informing PeopleOne Health of healthcare services received outside the network
Maintaining current contact and insurance information
Health and Safety Responsibilities
Member understands their responsibility to avoid exposing themselves or others to disease or danger and agrees to follow health and safety guidance provided by PeopleOne Health clinicians.
Complaint Process and Dispute Resolution
Internal Complaint Process
Member has the right to fair, fast, and objective review of complaints regarding clinicians, staff, wait times, operating hours, conduct, business practices, and adequacy of services. Member agrees to first bring complaints to PeopleOne Health staff and participate in the internal complaint and grievance process.
Contact Information for Complaints
Complaints may be submitted to:
Email: compliance@peopleonehealth.com
Phone: 1-888-330-6891 x5
Mail: PeopleOne Health, Inc., PO Box 123, Oakmont, Pennsylvania 15139
Protected Health Information and Privacy
HIPAA Authorization
Member acknowledges that PeopleOne Health is a HIPAA Covered Entity and authorizes the collection, use, and disclosure of Protected Health Information (PHI) as described in PeopleOne Health's Notice of Privacy Practices, which is incorporated by reference and available at [website] or upon request.
PHI Use for Service Delivery
Member specifically authorizes use of PHI for:
Treatment coordination with Care Partners
Payment processing and billing activities
Healthcare operations and quality improvement
Communication regarding treatment alternatives and health-related services
STATUTORY DISCLOSURE REGARDING INSURANCE
This agreement is not health insurance and the health care provider will not file any claims against the patient's health insurance policy or plan for reimbursement of any health 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.