Membership Eligibility Criteria

To ensure compliance with federal regulations and optimize care access, participation in the Open Arms Membership Program is subject to the following eligibility requirements:

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Age: Must be 18 years or older.

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Insurance Status:

       - Individuals not currently enrolled in Medicaid or Medicare are eligible.

       - Individuals with no insurance or private/commercial insurance may enroll.

       - Enrollment is not available to individuals actively receiving benefits under Medicaid or Medicare due to federal billing

         restrictions associated with membership-based care models.

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Residency: Must reside in Mississippi

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Payment Compliance: Must agree to monthly payment terms and adhere to the program’s delinquency policy.

 

Informed Consent: Must sign an acknowledgment that the Membership Program is not health insurance and does not cover emergency services, hospitalizations, or specialist care.

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Agreement to Terms of Membership

By signing below, I acknowledge that I have received, read, and understand the terms, conditions, and benefits associated with the Open Arms Healthcare Center Membership Program, including the selected tier of service. I agree to abide by the program’s policies, including payment terms, service exclusions, cancellation guidelines, and medical necessity provisions as outlined in the official Membership Program document. Membership benefits begins on the 1st of the month.

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Consent for Care and Services

I consent to receive healthcare services from Open Arms Healthcare Center and understand that care may include wellness visits, telehealth, labs, screenings, and other services based on my membership tier. I understand that services provided under this membership do not constitute comprehensive health insurance and that emergency care, hospitalization, or specialist referrals are not included.

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Financial Agreement

I understand that:

• Membership fees are due monthly unless paid annually in advance.

• Missed payments may result in suspension of benefits after the 5 business day grace period.

• If I choose to rejoin the program after cancellation or suspension, within the 12-month enrollment period, the account balance must be paid.

• No refunds will be issued for early cancellation. Partial months are prorated.

• Additional services not covered under my selected tier will be available at a discounted rate (30%).

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Policy Statement
Your prorated membership fee is based on your registration date and is valid only through the end of the current month.
If payment is not received by the first day of the following month, your invoice will be voided and a new invoice will be generated reflecting the updated (higher) fee for that month.

 

Membership benefits will not begin until payment is received and processed.

 

 

Privacy and Data Protection

I acknowledge that my health information will be maintained in accordance with HIPAA and Open Arms' privacy practices. I authorize the use and sharing of my protected health information for the purpose of care coordination, program management, and as otherwise required by law.

 

 

Use of Feedback

I agree that feedback I provide about my experience may be used (anonymously) to improve the Membership Program and inform patient engagement practices. I understand that I may be contacted to participate in patient satisfaction surveys or advisory groups.

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Changes to Membership or Tier

I understand that:

• I may only change tiers during my annual renewal period unless a documented medical necessity is determined by a licensed Open Arms Healthcare Center provider.

 

• Medical necessity will be evaluated and determined by a licensed Open Arms Healthcare Center provider, based on a clinical assessment and supporting documentation. The provider must complete a standardized Medical Necessity Form, which will be reviewed and approved by both the provider and the Membership Program Administrator. Tier changes under this condition are only permitted to the next higher tier and must be recorded in the patient’s electronic health record with clinical justification. Members will be notified of the decision in writing within 10 business days.

 

• If a patient presents with symptoms consistent with a sexually transmitted infection (STI/STD), a clinical evaluation will be performed. If empirical treatment fails, the provider may determine that laboratory testing is medically necessary. In such cases, the patient is responsible for the lab fees, which will be billed at a 30% discounted rate. No testing will be performed without informed consent, and all medical necessity decisions will be documented in the patient record.

 

• Re-enrollment will require settlement of any outstanding balance.

 

 

Termination of Agreement

This agreement remains in effect for a 12-month term and will automatically renew unless I submit written notice of cancellation prior to the renewal date. I understand my benefits terminate at the end of my current billing cycle if I cancel.

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Complaints and Dispute Resolution

Members who wish to dispute a decision or file a formal complaint regarding their membership experience, tier determination, service eligibility, or billing concerns may do so by submitting a written request to the Member Services Department. Complaints may be delivered by email, phone, or mail. Complaints will be acknowledged within five (5) business days and reviewed by the Membership Program Review Committee. A written response will be issued within fifteen (15) business days. If the member is unsatisfied with the outcome, a secondary review may be requested, which will be escalated to the Chief Executive Officer for final determination. All proceedings will be handled in compliance with HIPAA and organizational protocols.

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Delinquency Policy

Membership is structured in a 12-month cycle beginning at the time of enrollment. Memberships are suspended after 1 missed payment. A grace period of one (1) business day will be provided before suspension is enacted. Re-enrollment is required to restart benefits and will require full payment of the remaining balance.

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Service Eligibility and Enrollment Cycle
Services may only be accessed while membership is active and current. Services do not roll over to future membership cycles. Patients may only upgrade or downgrade their tier during the renewal window or with documented medical necessity. Medical necessity must be determined by an Open Arms clinical provider and documented in the patient’s health record. Tier changes outside the renewal window are only allowed to the next level up.

Non-Transferable
Benefits apply solely to the enrolled member.

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Disclaimer

This program is not insurance. It does not cover emergency care, hospitalization, or specialist services.

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Data Privacy and HIPAA Compliance

All patient information will be handled in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Open Arms Healthcare Center is committed to protecting the confidentiality, integrity, and security of all personal health information shared through the membership program.

Dispute Resolution Policy
Members who wish to dispute a decision or file a formal complaint regarding their membership experience, tier determination, service eligibility, or billing concerns may do so by submitting a written request to the Member Services Department. Complaints may be delivered via, phone, email, or through the online member portal.

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Upon receipt, the complaint will be acknowledged within five (5) business days and reviewed by the Membership Program Review Committee. A written response outlining the resolution or next steps will be issued within fifteen (15) business days. If the member is unsatisfied with the outcome, a secondary review may be requested, which will be escalated to the Chief Executive Officer for final determination. All proceedings and documentation will be maintained in accordance with HIPAA and internal compliance protocols.