PEDIATRIC URGENT CARE INC (PUC®)-BLOCK FEE SUBSCRIBER AGREEMENT – (PUC® Block Fee)
Agreement: Pediatric Urgent Care Inc. (PUC®) provides both insured and uninsured
services. The fee paid by a PUC® client (Subscriber) is for uninsured services ONLY and is unrelated
to any insured services that a Subscriber may require or obtain through PUC®. Ontario Provincial
Insurance Plan (OHIP) does not cover several services requested by our clients. Services that OHIP
does not pay for are called “non-insured or uninsured services,” and it is illegal or fraudulent for
doctors to bill OHIP for them. To ensure a high level of client service, PUC® must charge for these
services. In consideration of the provision of uninsured services by Pediatric Urgent Care Inc. (“PUC®”),
payment for such services, and other good and valuable considerations the receipt and adequacy of
which is acknowledged, the parties agree as follows ("Agreement"):
Uninsured Services: Services provided by physicians that are not publicly funded
under OHIP (e.g., prescription refills over the phone, copy or transfer of medical records, etc.).
This includes services provided to individuals not insured under OHIP (Appendix A).
Block Fee: A fee that is charged to patients to pay for the provision of one or more
uninsured services from a predetermined set of services during a predetermined period of time. At
the time of payment, it will not be possible for the patient to know how many, if any, services will
be needed.
- a. The Subscriber has the option of paying for each service individually; not paying the block fee does not affect the Subscriber's ability to access healthcare services.
- b. Payment of a block fee is OPTIONAL, and the Subscriber may choose to pay for uninsured services as they are provided.
- c. The Subscriber confirms that the decision to pay a block fee is in their best interest, given their needs or usage of uninsured services.
- Services: For the Block Fee or the Pay Per Service (PPS) fee option the Subscriber chooses to purchase, PUC® agrees to provide the Subscriber with the uninsured services listed in Appendix A during the term of the Agreement. If the Subscriber has opted to pay the Block Fee, the fees outlined in Appendix A will not apply for the term of the Agreement. The prices listed in Appendix A are subject to change. All forms of digital medical advice will be responded to during the same or the next business day. We are not responsible for changes in your patient's medical condition(s). All digital (electronic) or virtual care including secured medical digital messaging is covered by OHIP and this PUC® Block fee isn’t for such virtual care services.
Term: This Agreement is effective for 12 months from the date of this Agreement (the
“Term”). The Subscriber has the opportunity to rescind their decision to pay a block fee within a
week of the original decision. If the Subscriber decides to rescind their decision, PUC® will refund
the amount charged for the block fee within two weeks, less the fees for uninsured services provided
plus ten percent of administrative fees. To cancel the subscription within a week, you can email: Blockfee@pediatricurgentcare.ca.
Renewal: This Agreement will be automatically renewed at the end of the Term for an
additional Term of the same duration. PUC® will provide the Subscriber with notice of renewal of
this Agreement at least 30 days before the end of the current term. The Subscriber will be notified
in writing of any changes to fees before renewals are processed. Any Subscriber renewal
correspondence will also form part of this Agreement.
Governing Law: This Agreement and all services pursuant to it shall be governed by
the laws of Ontario and Canada applicable therein, and the parties hereby irrevocably submit to the
exclusive jurisdiction of the courts of Ontario.
Privacy:
- a. In accordance with PUC®’s Privacy Policy, PUC® will collect, use, and disclose the Subscriber's personal health information (“PHI”) to other parties as reasonably necessary to: provide or assist in providing the Subscriber with health care; determine or verify the Subscriber's eligibility to receive health care and related goods or services; obtain payment for the Subscriber's health care, including from any third party; conduct health system planning and research; and, as permitted or required by law.
- b. The provision of health information and educational material is a core feature of the PUC® service offering. By accepting this Agreement, the Subscriber agrees that PUC® may use the Subscriber's email address and other contact information in their profile for the purposes of providing the Subscriber with information, newsletters, invitations, offers, and other communications in relation to PUC® services (“PUC® Communications”) in accordance with the Subscriber's preferences. The Subscriber can change their preferences by notifying PUC® at BLOCKFEE@PEDIATRICURGENTCARE.CA.
- Release: The Subscriber agrees and acknowledges that, in delivering the Services to the Subscriber, PUC® and its employees, directors, and officers from time to time contract solely as an agent for and on behalf of the Subscriber for the delivery to the Subscriber of the Services by third-party independent contractors (a “Contractor”). The Contractors providing the Services to the Subscriber include, but are not limited to, physicians, radiologists, optometrists, as well as others. Where the delivery of the Services is made to the Subscriber by a Contractor, the Subscriber acknowledges that PUC® is solely acting as an agent for and on behalf of the Subscriber, making arrangements with a Contractor, through facilities of PUC®, for the delivery of the Services, and not as a principal. Save and except as a result of a negligent act of PUC®, the Subscriber hereby releases PUC® from any claims, losses, costs, or liabilities (“Claims”) of any nature arising out of any Services provided to the Subscriber by a Contractor.
Termination: PUC® may terminate this Agreement immediately if the payment required under this Agreement is in arrears for 30 days or for breach of any of the terms or conditions in this Agreement upon 15 days written notice to the Subscriber. The Subscriber may terminate the annual renewal with a 30-day written notice to PUC® at BLOCKFEE@PEDIATRICURGENTCARE.CA prior to the annual renewal date of the Agreement. No refund is issued after the probationary 7 days of subscription.
Contact Information: For any questions or privacy matters with respect to this Agreement, please contact PUC® via 106-222 DIXON RD, TORONTO, ON, or email at BLOCKFEE@PEDIATRICURGENTCARE.CA.
Appendix A
Service PUC Block Fee | Subscriber | Pay Per Service |
---|---|---|
Single Missed appointment / late cancellation within 24 hours | Included | $125 |
Single Late arrival for appointments (MORE THAN 10 MINUTES) | Included | $50 |
Uninsured UNLIMITED Nurse Support (EMAIL/MESSAGING ADVICE DURING BUSINESS HOURS) | Included | $25/Email |
Insured PEDIATRICIAN/NP DIGITAL MESSAGING ADVICE (BUSINESS HOURS) (i) | Included | |
Unlimited Prescription refills | Included | $25/Refill |
Unlimited Replacement of lost prescription | Included | $25 |
Transfer/request of medical records | Included | $50-$75 |
Unlimited Completion of documentation/forms for physicals for schools, camps, preschool, daycare, university/educational institutions | Included | $30-$50 |
Unlimited Back to work notes, sick note, or daycare note | Included | $30 |
Online Virtual Care (Telemedicine) (i) | Included | |
Open Online Access to Test Results (Un) | Included | $15 |
Open Online Access to Medical Records (Un) | Included | $30 |
CRA Verification Letters | Included | $75/Letter |
Replacement of Lost Immunization Cards | Included | $50/Card |
Single Discounted Pediatric Travel Consultation/Travel Health (30% Discount) | 30% Discount | Full Fees |
Single Free Administration of Travel Vaccines | Free | $30/Injection |
Online Self-Check-In (In-Person Visits) (i) | Included | |
Single Introductory consultation with a Registered Pediatric Dietitian/Term | Included | $40/15 Min |
Single Introductory Consultation with a Pediatric Homeopath/Term | Included | $40/15 Min |
Single Introductory Consultation with a Pediatric Chinese Medicine and Acupuncturist/term | Included | $40/15 Min |
Single Introductory Consultation with a Pediatric Feet Health Specialist (Health of your child’s feet)/Term | Included | $40/15 Min |
Single Introductory Consultation with a Pediatric Naturopath/Term | Included | $60/15 Min |
Single Introductory Consultation with a Registered Child Life Specialist/term | Included | $40/15 Min |
Single Introductory Consultation with a Pediatric Registered Psychotherapist/Term | Included | $50/15 Min |
Single Annual Pediatric Integrative Medicine (PIM) Report Review (NP) | Included | $400 (per report) |