Membership Renewal

Applicant

Member ID

Membership renewal fee:

For example: 125.50 (No dollar "$" sign)

(You can find the renewal amount on your Healthcare Resources renewal letter. If you would like to make any changes on your membership plan, please call member services at 1-888-891-6302.)

If the infomation is correct, please click "I Agree" to accept the terms and proceed to our secure payment web site to finish the transaction.

Terms

HEALTHCARE RESOURCES TERMS AND CONDITIONS
INDIVIDUAL NETWORK ACCESS AGREEMENT AND DISCLOSURE

This individual Network Access Agreement (“Agreement”) is made and entered into by and between Healthcare Resources, (a non-profit organization) (“Company”) and (“Subscriber”), with respect to the membership of subscriber and his/her spouse and minor children (collectively, “Members”) in Company’s discount program (“Membership”).

THIS IS NOT AN INSURANCE PRODUCT!!

1.	Description of Services Members are entitled to receive discounts and other benefits on specified health-related products and services (collectively, “Services”).  These Services, along with their related discounts and benefits, are explained in the membership package that accompanies this Agreement, and are subject to change, modification, or substitution without notice. Members are required to present their membership card at the time services are rendered.
2.	Network of Providers Company has established a network of health care providers who have agreed to provide services at a discount to persons who have purchased membership in company (“Network Providers”).  All Services ordered are subject to the availability of such Services.
3.	Payment of Network Providers Members shall pay Network Providers directly for services provided to them at the discounts and other rates set forth in the materials distributed to Members from time to time.  Members shall pay Network Providers at the time Services are received or within thirty (30) days of receipt of the Network Provider’s bill for services.  Failure to timely pay a Network Provider may result in Company’s termination of this agreement. Member may not negotiate with provider. Failure to adhere to this rule may result in Company termination of this Agreement.
4.	Term and Termination  
a.	The term of this Agreement shall begin on the date Company approves Subscriber’s application for membership (“Application”) and shall end one year later, unless renewed as provided below.
b.	Company may terminate this Agreement at any time by giving written notice to Subscriber.  If Company terminates this Agreement it shall normally provide Subscriber with at least 30-days prior written notice.  However, if Subscriber fails to pay the Membership fee, or if a Member violates any provision of this Agreement, Company may cancel this agreement without providing Subscriber with 30-days advance notice.
c.	Subscriber may terminate this Agreement at any time before approval, by giving written notice to company.  This agreement shall terminate effective as of the date company receives Subscriber’s notice of termination.  If Subscriber terminates this Agreement prior to approval of the Application, Subscriber shall be liable to Company for a $20.00 service fee.  Company shall refund the remainder of the membership fee to Subscriber.  Subscriber shall not be entitled to a refund of any of the membership fee after approval of the application. If checks are returned by the bank, Subscriber shall be liable to Company for a 20% service charge plus any Bank charges incurred by Company.
5.	Renewal and Billing  
a.	Company shall bill Subscriber for the fee for renewal of this Agreement and the Membership semi-yearly/yearly.  Subscriber must remit payment of the renewal fee and proof of income to Company on or before the date printed on the billing statement in order to renew this Agreement and the Membership.  Company shall notify Subscriber in advance of any increase in the Membership fee.
b.	Proof of income is a copy of the Member’s most recent pay stub or if such is not available, a signed statement from Member’s employer, indicating the Member’s gross monthly income and the dates received.  A copy of the Member’s last year’s federal income tax return may be submitted if the above is not available.  Proof of income also includes the following:
(1)	If the Member is self-employed, the member’s last year’s federal income tax return (with a schedule C) or the profit and loss statement from the last 3 months.
(2)	If the Member has income such as disability or retirement income, copies of award letters or bank statements showing the direct deposits.
(3)	If the Member receives child support and/or alimony or spousal support, copies of the checks received or statements from the District Attorney’s Family Support Division, for the last month.
6.	Assignment and Use of Membership This Agreement and the Membership are not assignable without Company’s prior written consent.  Subscriber agrees to use the Membership only for his/her personal use or for the benefit of his/her spouse and minor children enrolled as Members.  Subscriber shall be responsible for contacting Company regarding any change in address, phone number or Members. Providers will verify eligibility.
7.	Disclaimer of Warranties Company is not a Provider of Services and is not involved in selecting Services or Network Providers for Members.  Accordingly, Company gives no warranty, expressed or implied, as to the quality or adequacy of Services rendered to Members by Network Providers.  In the event a Member is dissatisfied with any Services, the Member shall look solely to the Network Provider for satisfaction of the Member’s claim.
8.	General Release Subscriber has the authority to bind the other Members to comply with the terms and conditions of this Agreement.  Subscriber, on behalf of all Members, releases, acquits and discharges Company from any and all liabilities, claims, demands, actions, and causes of action that a Member or a Member’s legal representatives may have by reason of any monetary damage or personal injury sustained as result of or during the use of any and all Services.  Subscriber acknowledges that the sole recourse available to a Member or a Member’s legal representative shall be termination of this Agreement and the Membership. The Authorized Application Assistant has no authority to promise or to modify Healthcare Resources Benefit.
9.	Notices Notices to Subscriber from Company shall be effective when deposited in the United States Mail, postage prepaid, addressed to Subscriber at the address shown on the signature page of this Agreement, or at such other address as may be shown on Company’s records, unless a longer period is specified in this agreement or required by law, which longer period shall start upon mailing of the notice.  Subscriber’s notice to Company shall be mailed to the address shown on the signature page of this Agreement (or other address as company may specify) and shall be effective when received by Company.
10.	Choice of Law This Agreement shall be governed by and construed and enforced in accordance with applicable federal laws and the laws of the State of California.
11.	Inclusion in Agreement The Application, the other materials contained in the application package, and the Member handbook, all may be amended by Company from time to time, shall be deemed a part of this Agreement.

DISCLOSURE

1.  HEALTHCARE RESOURCES IS A HEALTH CARE DISCOUNT PROGRAM FOR THE UNINSURED, LIMITED INCOME FAMILIES AND INDIVIDUALS. NOT AN INSURANCE PRODUCT.
2.  HEALTHCARE RESOURCES PROGRAM IS A NON-PROFIT ORGANIZATION, NOT AFFILIATED WITH ANY GOVERNMENT AGENCY.
3.  TO REALIZE ANY HEALTH CARE BENEFITS, MEMBER HAS TO USE PROVIDERS FROM HEALTHCARE RESOURCES PROVIDER LIST. 
4.  PROVIDER LIST IS PROVIDED FOR REFERENCE PURPOSE ONLY, AND MAY CHANGE WITHOUT PRIOR NOTICE. PLEASE CALL MEMBER SERVICES FOR UPDATED PROVIDER INFORMATION.
5.  IF YOU HAVE A PROBLEM SCHEDULING AN APPOINTMENT FROM A PROVIDER ON OUR LIST, PLEASE CONTACT MEMBER SERVICES IMMEDIATELY.
6.  YOUR OFFICE VISIT FEE DOES NOT INCLUDE ANY OFFICE PROCEDURES, LAB WORK, RADIOLOGY AND MEDICATIONS. YOU NEED TO PAY FOR THESE SERVICES AS THEY ARE RENDERED 
     BY HEALTHCARE RESOURCES PROVIDERS. OFFICE PROCEDURES DISCOUNTED UP TO 50% OFF.
7.  HEALTHCARE RESOURCES IS A DISCOUNT HEALTH CARE MEMBERSHIP PROGRAM.  NO REFUND WILL BE GIVEN AFTER APPROVAL OF YOUR APPLICATION.  MEMBERSHIP IS ALSO NOT 
     TRANSFERABLE.
8.  IT IS YOUR RESPONSIBILITY TO INFORM HEALTHCARE RESOURCES IF YOU HAVE NOT RECEIVED YOUR MEMBERSHIP CARD(S) WITHIN 30 DAYS.
9.  HEALTHCARE RESOURCES PROGRAM IS SUPPORTED BY THE PROVIDERS WHO ARE WILLING TO GIVE THEIR BEST RATES TO HELP THE UNINSURED, LIMITED INCOME FAMILIES AND 
     INDIVIDUALS. FEES FOR ANY MEDICAL SERVICES ARE PRE-NEGOTIATED AND USUALLY ARE THE LOWEST RATE AVAILABLE FROM OUR PROVIDERS. PLEASE DO NOT ASK FOR ADDITIONAL   
     DISCOUNTS FROM OUR PROVIDERS. 
10. NOT ALL GENERIC MEDICATIONS ARE TEN DOLLARS.  NAME BRANDS AND EXPENSIVE GENERICS WILL BE DISCOUNTED AT A SPECIAL RATE FOR MEMBERS.

Alternate Payment Instructions

Ordering with a credit card is safe through our secure order page; however, if you do not have a credit card or just aren’t comfortable placing your application online or with a credit card, you have several alternatives:

Apply by Mail

Click on the “Printable version” button to print out the summary page and sign it.
Make check/money order payable to HEALTHCARE RESOURCES
Mail your payment with the application summary to:

Healthcare Resources
P.O. Box 6603
Rosemead, CA 91770

Apply by Phone

Call 1 888 891-6302 and we can take your credit card payment over the phone

Apply by Fax

Click on the “Printable version” button to print out the summary page and sign it.
Write your credit card number and expiration date on the summary page or separate sheet of paper. If your billing name or address are different than on the summary please provide that information as well
Fax your application summary with credit card information to 1 888 396-5124

Once your application is approved your membership packet with membership cards will be sent to you in about 2 weeks. If you have any questions, feel free to contact us at 1 888 891-6302.