OverC Health Management Service Agreement

BETWEEN:    OVERC PERSONAL HEALTH MANAGEMENT INC.

(sometimes, “OverC”, “us”, “we” or “our”)

AND                           

                                                                                                                                                                   

(sometimes, “client”, “you” or “your”)                               (client email)

 

1. Definitions and Interpretation. Unless otherwise defined in the body of this Agreement, all capitalized words have the definitions attributed to those terms in Schedule “A” – Definitions.

2. Services

2.1. Membership Plans. You agree to join and we agree to accept you as a member of one of the following personal health management Memberships on the terms and conditions set out in this agreement:

 (check the box of the applicable health management Membership)

[   ]  ALa Carte – a onetime fee of $250 + pay per use Services on client request.

The A’ La Carte Membership includes access to all Services on a pay per use basis. Services are available upon the reasonable request of the client at the rates set out in our Pricing Table.

[   ]  Overture – a onetime fee of $250 + $95/month + pay per use Services on client request.

The Overture Membership includes ongoing Health Record Maintenance and access to an OverC Health Care Professional and their Team for Navigation. Other Services, including Connections, Appointment Management and Appointment Escort are available on a pay per use basis upon reasonable request of the client at the reduced rates set out in our Pricing Table.

(hereinafter, your “Membership”)

All membership plans include an Interview and Health Record Creation.

 

2.2. Requesting a Service. Members may request a Service by phone or email during regular business hours. Our office hours are 9:00am - 5:00pm, Monday through Friday, except statutory holidays. We will make our best efforts to accomodate your schedule in providing the Service but cannot guarantee the timeliness of the Service or our availability schedule. Services will only be carried out if they have been confirmed by us via email or phone. The location where a Service shall be carried out will be determined upon requesting a Service.  

2.3. Pay Per Use Services. A pay per use Service includes any Service that you request, which is not included in your Membership fee; and in the case of A’ La Carte Memberships, any Service. Whenever you request a pay per use Service, we will provide you with a cost estimate of the Services requested based on the information you provide to us. We will not provide you with the pay per use Service until you have approved our estimate. Pay per use Services are charged in minimum 10 minute intervals. While we make every attempt to provide accurate estimates, we are not bound by the cost estimate we provide and our invoiced amount may be higher or lower. If the cost of the fee differs from our estimate, we will notify you before you are billed.

2.4. Cancelling a Requested Service. Requested Services may be cancelled by a client upon providing 24 hours’ notice to us by phone or by email. If you do not provide us with sufficient notice, you will be responsible for paying our cost estimate, in the case of pay per use Services.

2.5. Term. The initial term of your Membership shall be 12 months. At the end of the initial term and of each subsequent term (if applicable), this agreement shall automatically renew for a subsequent term of equal length unless either party gives notice in writing to the other party to terminate the membership at least 30 calendar days prior to the last day of the term.

2.6. Termination. Either party may terminate this agreement upon 30 days’ notice in writing to the other party. This agreement shall also terminate immediately upon the death or incapacity of a client. Where your Membership terminates on a day that is not the last day of a calendar month, the Fee (excluding pay per use Service fees, which shall be charged as set out in section 2.1) shall be reduced in proportion to the number of calendar days in that month for which your Membership is not active.

3. Payment

3.1. Fee Payment. In consideration of your Membership, you agree to pay us:

            (a) a onetime fee of $250;

            (b) a monthly fee of $                                     ;

            (c) all pay per use Service fees; and

            (d) applicable taxes and Disbursements.

            (collectively, our “Fee”).

This means you agree to pay us $                      (inclusive of taxes and Disbursements) upon signing this Agreement. Hereafter, our Fee shall be due and payable on the first business day of every month during the term. We will apply all pay per use Service fees incurred within any one month to our Fee for the following month. For example, all pay per use Service fees incurred in January shall be due and payable with the Fee payment on the first business day of February.

3.2. Pre-authorized Payments. You agree to pay our Fee by way of pre-authorized monthly payments from a credit or chequing account at a banking institution acceptable to us. We will charge your account on the first business day of every month during the term of your Membership and, in the event there are any pay per use Service fees incurred in the last month of the term, upon the first day of the month immediately following the term of your Membership. You agree to complete the pre-authorized payment form attached hereto as Schedule “B” – Pre-Authorized Payments.

3.3. Invoices and Receipts: We will send you an email confirming payment of our Fee upon receipt of payment from you.  In the event any Fee or any part of our Fee is not paid in full on the first business day of the month, we will send you an email invoice with respect to our outstanding Fee.

3.4. Late Payments: Any unpaid portion of our Fee outstanding after 30 days shall bear interest at 8% per annum until such amounts have been paid. We will charge you a $25.00 administration fee if a pre-authorized payment is not processed for any reason.

3.5. Increases in Price: We may increase all or any part of our Fee at any time during the term of your Membership by giving you email notice 30 days in advance of the increase in Fee and a copy of our updated Pricing Table.

4. Information

4.1. Client Information. You consent to OverC accessing, holding and sharing your Personal and Health Information in the course of providing you with the Services. Any Personal and Heath Information of yours that we access, hold or share during the term of this agreement remains your property. We will only share your Personal and Health Information with your consent, which may be written or verbal.  We are not liable for any Consequences that arise as a result of us accessing, holding or sharing your Personal or Health Information, provided we do so in the course of carrying out the Services pursuant to this Agreement. We will not maintain a copy of your Health Record on our files. We will retain copies of our notes, as described in Section 4.3.

4.2. Client Information upon Termination of Membership: Upon the termination of your Membership we will use our reasonable best efforts to return to you any original documents in our possession without delay on our part. In the event of a client loss of capacity or death, we will return any original documentation in our possession to any person who we have reason to believe is entitled to your property upon the occurrence of either of the two occurrences. We will keep our records of your file for a period of seven years following termination of your Membership. This will assist us in restarting a Membership should you decide to re-subscribe, and you may request a copy of your file at any time before it is destroyed.

4.3. Cloud-Based Record Storage: In order for us to provide you with the Services throughout the term of your Membership, you must have an account with a cloud-based records storage provider acceptable to us. You recognize and agree that we may not be able to provide a certain Service, or in some instances, any Services, until and unless you obtain such an account. You are responsible for this account prior to (if applicable), during and after the term of your Membership. Your Health Record will be stored and (to the extent you request the Personal Health Record Management Service) maintained on your cloud-based records account. You are also solely responsible for your relationship with the account provider in accordance with such provider’s terms and conditions. Under no circumstance shall OverC assume or be deemed to assume any liability as a result of the uses made of any such account.

4.4. Privacy Policy: We will hold your Personal and Health Information in accordance with our Privacy Policy which we may update from time to time without notice to you. See the terms of our Privacy Policy in Schedule “C” – Privacy Policy attached hereto.

5. Terms and Conditions. OverC does not provide, nor does it pretend to provide (1) any assistance in reducing wait times related to health care services; (2) any assistance in securing the services of health care providers; or (3) any medical prescriptions or procedures.

We do not make any representation or warranty as to the success or perceived success of the Services to be provided in accordance with this Agreement. Further, our Services will only be as thorough and the Health Records we assist to create will only be as complete as the information and knowledge made available to us by you or by those from whom we obtain such information on your behalf. Accordingly, you acknowledge and agree that your only remedy for any breach or perceived breach of this Agreement by us is for you to terminate this Agreement in accordance with its terms.

6. Limitation of Liability. We assume no liability for errors or omissions in your Health Records or any Consequence arising therefrom, even where those errors or omissions may have been caused by our actions or omissions, save for material errors caused by us through gross negligence. We assume no liability for any communication (or the Consequences of such communications) made to any other person within the scope of this Agreement, provided we had your consent. We assume no liability for any use or misuse of your cloud-based records account or for any Consequence arising therefrom.

7. Miscellaneous. This Agreement, including all schedules attached hereto, is the entire agreement between the parties with respect to the subject matter of the agreement and supersedes all prior understandings and discussions, whether oral or written and there are no warranties and representations between the parties except as specifically set out in this agreement. In particular, any of our website content not specifically referenced or incorporated herein, shall not be binding on us.

Notice from one party to the other shall be sufficiently provided if provided by email to the respective addresses set out herein. Notice shall be deemed to be delivered on the day the email is sent, or if such email is not sent within our business hours, upon the next business day.  You may also request that we send all correspondence and notices to you via post. If so, your postal address is as follows, and notice sent via mail shall be deemed to be received 3 business days following the day it was post marked: 

 

                                                                                                                              

(Address)

 

Each party shall be responsible for updating the other party of any change in email or postal address.

This Agreement shall be governed by the laws of the Province of Saskatchewan and the relevant federal laws applicable therein.

This Agreement shall be binding on and enure to the benefit of the parties hereto, and their respective heirs, executors, administrators, successors and permitted assigns.

 

Intending to be bound by this Agreement, the parties have, in their own hand or by the hand of their authorized representatives, signed on this              day of                                 , 20        .

 

OVERC PERSONAL HEALTH MANAGEMENT INC.

 

Per:                                                         

Title:

Name:

 

 

                                                                 

(Client signature)

 

SCHEDULE “A” – Definitions

The following terms shall have the meanings ascribed to them:

a.“Agreement” means the Personal Health Management Agreement concluded between OverC and the Client on the day written therein.

b.“Appointment Escort” means the service where an OverC Team member accompanies you to an appointment in order to assist you in articulating your requests, taking notes from that appointment and adding the to your Health Record.

c.“Appointment Management” means the service where OverC will assist you in scheduling, cancelling, amending or otherwise managing appointments upon your instructions including adding the outcome report to your Health Record, and providing email or telephone reminders to you.

d.“Connections” means the service where OverC will have regular contact as agreed with the client, if requested communicate and document on behalf of the client with their health care providers, and share health information with health care providers as directed by the client.

e.“Consequences” means any claim, cause of action, damage, cost, harm, loss or any other grounds that may give rise to legal liability.

f.“Disbursements” mean those out of pocket costs that we incur in providing you with the Services.

g.“Health Record” means a digital health record that OverC will assist you in creating on your cloud-based record account. The Health Record will be used throughout the term of your Membership.

h.“Incapacity” means the incapacity of a client as evidenced by the written confirmation of one medical professional, or by an order of a court of competent jurisdiction.

i.“Interview and Health Record Creation” means the initial client interview and creation of the clients Health Record.

j.“Membership” means your membership with OverC as selected in section 2 of the Agreement.

k.“Navigation” means the service where OverC provides you with information or references with respect to navigating the health care system, the availability of particular health care services and or help you find the information you need to get the treatment and medical advice you seek.

l.“Personal Health Record Maintenance” means the service where OverC updates, organizes and maintains your Health Record from time to time with (1) digital copies of your health records generated from health care providers; or with (2) notes taken by the OverC Team in carrying out the Services.

m.“Personal and Health Information” means any of the clients personal or health information provided to or made available to OverC in any form and by any means, and which includes but is not limited to the clients information in the Health Record, from time to time.

n.“Pricing Table” means the pricing table of Services in force from time to time and as published on the OverC website [www.overchealth.ca].

o.“Service” means any one of the following and “Services” means two or more of the following:

i.    Interview and Health Record Creation;

ii.   Personal Health Record Maintenance;

iii.  Navigation;

iv. Appointment Management;

v.  Appointment Escort; and

vi. Connections.

 

SCHEDULE “B” – Pre-Authorized Payments

Payor’s PAD Agreement

(Pre-Authorized Debit)

Instructions:

  1. Please complete all sections in order to instruct your financial institution to make payments directly from your account
  2. Please refer to Service Agreement for Terms and Conditions
  3. Return the completed form with a blank cheque marked “VOID” to the OverC at the address noted
  4. If you have any questions, please write or call OverC (306.934.2535)

 

Payor Information (Please type or print clearly)

Payor Name(s):

Address:

Telephone:

 

Signature of Payor(s):

 

Date:

 

Payor Financial Institution/Banking Information (Please type or print clearly)

 

Branch Number:

 

Institution:

 

Account Number:

Name of Financial Institution:

Branch:

Branch Address:

City/Province:

Postal Code:

       

 

Payor Information (Please type or print clearly)

Payee Name:       OverC Health Management

Address:              106B – 3929 8th Street E.

Telephone:          306.934.2535

Email:                  admin@overchealth.ca

 

 

SCHEDULE “C” – Privacy Policy

Privacy Policy – As at January 1, 2015

OverC Personal Health Management is committed to safeguarding the Personal Information entrusted to us by our clients. We manage your Personal Information in accordance with The Health Information Protection Act (HIPA) and other applicable laws. This policy outlines the principles and practices we follow in protecting your Personal Information.

This policy applies to OverC Personal Health Management; OverC will require any person or third party company providing services on OverC’s behalf to comply with this policy. A copy of this policy is provided to any client on request.

What is personal Information?

Personal Information means information about an identifiable individual. This includes an individual’s name, home address and phone number, age, sex, marital or family status, an identifying number, financial information, etc. For the purposes of this policy, Personal Information includes Personal Heath Information, which is: information with respect to the physical or mental health of an individual or with respect to any health services provided to that individual.  Personal Health Information also includes information collected in the course of providing health services or incidental to the provision of health services, and also includes health registration information.

What Personal Information do we collect?

We collect only the Personal Information needed for the purposes of providing services to our clients, pursuant to the Membership Agreement (“Services”). If collection of Personal Information occurs for any other purposes, we will inform our clients of such purpose at the time of collection, unless information is provided for an obvious purpose (i.e.: provision of credit card information to pay a membership fee or invoice).  We normally collect Personal Information directly from our clients.  In some circumstances, we may collect Personal Information from third parties, including “trustees” who have provided health services to a client, within the contemplation of HIPA, but such collection will occur only with a client’s consent, or as authorized by law. 

Consent

We will obtain a client’s express consent to collect, use or disclose client Personal Information, for the purpose of providing the Services, except in specific circumstances, where collection, use or disclosure without consent is authorized or required by law. Consent will be implied where information is supplied for an obvious purpose.

We may not be able to provide Services to a client who will not consent to the collection, use or disclosure of certain Personal Information that is necessary for us to fully and effectively provide those Services. Where express consent is needed, we will normally ask clients to provide their consent orally (in person or by telephone), or in writing (by signing a consent form).

A client may withdraw consent to the use and disclosure of Personal Information at any time, unless the Personal Information is necessary for us to fulfill our legal obligations. We may be unable to or decline to provide you with Services if we do not have the necessary Personal Information.

We may collect, use or disclose client Personal Information without consent only as authorized by law. For example, consent will not be required when the collection, use or disclosure relates to an emergency that threatens a person’s life, health or safety.

How do we use and disclose Personal Information?

We use and disclose client Personal Information only for the purpose for which the information was collected, except as authorized by law.  If we wish to use or disclose client Personal Information for any new purpose, we will ask for the client’s consent. We may not seek consent if the law allows this (e.g. for the purpose of collecting a debt).

How do we safeguard Personal Information?

We make every reasonable effort to ensure that Personal Information is accurate and complete. We rely on individuals to notify us if there is a change to their Personal Information that may affect their relationship with our organization. If a client is aware of an error in our information about themselves, they should let us know and we will correct it on request wherever possible. In some cases we may ask for a written request for correction.

We will use physical, technical and administrative safeguards in order to protect Personal Information in a manner appropriate for the sensitivity of the information. We make every reasonable effort to prevent any loss, misuse, unauthorized access, disclosure or modification to Personal Information.

We use appropriate security measures when destroying Personal Information, including shredding paper records and permanently deleting electronic records.

We retain Personal Information only as long as is reasonable to fulfill the purposes for which the information was collected or for legal or business purposes.

Access to records containing Personal Information

Clients have a right to access their own Personal Information in a record that is in the custody or under the control of OverC Personal Health Management, subject to some exceptions. For example, organizations are required under The Personal Information Protection and Electronic Documents Act to refuse to provide access to information that would reveal Personal Information about another individual.

If we refuse a request in whole or in part, we will provide the reasons for the refusal. In some cases where exceptions to access apply, we may withhold that information and provide a client with the remainder of the record.

A client may make a request for access to their Personal Information by writing to Perry Kimber, Privacy Officer, OverC Personal Health Management. A client must provide sufficient information in your request to allow us to identify the information they are seeking.

A client may also request information about our use of their Personal Information and any disclosure of that information to persons outside our organization. In addition, a client may request a correction of an error or omission in their Personal Information.

We will respond to a client request within 30 calendar days, unless an extension is required, in which case we will confirm that to the client. We may charge a reasonable fee to provide information, but not to make a correction to information that is inaccurate on our file. We do not charge fees when the request is for personal employee information (if applicable). We will advise clients of any fees that may apply before beginning to process their request.

Changes

Our Privacy Policy may change from time to time. We will not reduce client rights under this Privacy Policy without their explicit consent. We will post any privacy policy changes on this page and, if the changes are significant, we will provide a more prominent notice (including, for certain services, email notification of privacy policy changes). We will also keep prior versions of this Privacy Policy in an archive for client review.

Questions and complaints

If a client has a question or concern about any collection, use or disclosure of Personal Information by OverC Personal Health Management, or about a request for access to their own Personal Information, they may contact Perry Kimber, Privacy Officer.

 

OverC Health Management

100-1202 Emerson Avenue

Saskatoon, SK S7H 2X1
 

Email: admin@overchealth.ca

Website: http://www.overchealth.ca

Phone: 306.934.2535

Fax: 306.934.2517