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This Agreement is entered into between the undersigned Practitioners (“Practitioners”) and D-CHIP, a private Health Care initiative whose members include individual Diasporas and Medical Member Companies.
D-CHIP has established a continental network of medical providers to support the delivery of the D-CHIP Health Insurance Program and potential other continental medical programs (“Diaspora-Care health Insurance programmes”) administered by a sponsoring D-CHIP Member Company (“JANERO Consultancy GmbH”). Practitioners wishing to become participating Practitioners in the Diaspora-Care health Insurance Programme and represents that Practitioners have a current, active license to practice within the jurisdiction(s) governing the country, office location(s) stated in each application.
1. D-CHIP agrees to include Practitioners in the Diaspora-Care health Insurance Programme directory for the Health Insurance Programme and any other Diaspora-Care health Insurance Programmes that may be offered while this Agreement is in effect. From time to time, D-CHIP or a Control Plan will notify Practitioners of the specific terms of such additional Diaspora-Care health Insurance Programmes.
2. Practitioners agrees to be bound by the terms and related policies and procedures of the Health Insurance Programme (including those clauses referenced in Exhibit 1 to this Agreement) and of any other Diaspora-Care Health Insurance Programme upon Practitioners’ receipt of notice thereof.
3. Practitioners agrees to perform professional services under Diaspora-Care health Insurance Programmes consistent with the quality of services provided to the balance of Practitioner’s practice and in accordance with the generally accepted standards of care in Practitioners’ community. Practitioners also agree to maintain professional insurance coverages with limits that are consistent with local custom and practice.
4. Practitioners agrees that the fees charged for covered services provided to enrollees under any Diaspora-Care Health Insurance Programme will not exceed the lesser of:
- Practitioner’s Usual and Customary (“U&C”) fees accepted under the terms of the Practitioner’s U&C fee agreement, if any,
- the fees submitted by Practitioners for payment, or
- the fees shown on the most recent applicable Schedule of Allowances that has been provided to Practitioners with respect to such program.
Practitioners authorize D-CHIP or JANERO Consultancy to obtain Practitioners’ U&C fees from the Practitioner’s local representative Company for the purpose of making this fee determination. Practitioners’ acceptance of a Diaspora-Care health Insurance Programme Schedule of Allowances will not affect the fees which Practitioners may charge to enrollees of other Medical programs or any other term of Practitioner’s agreement with local Medical programmes.
5. Practitioners agree to abide by D-CHIP policies and procedures of which Practitioners are notified. Practitioners further agrees to abide by the Processing Policies that are provided to Practitioners with respect to the Health Insurance Programme and any other Diaspora-Care health Insurance Programme, including without limitation the requirement that Practitioners bill and collect from enrollees for covered services the applicable deductibles, coinsurance, or amounts exceeding contractual maximums, and no more. Unless the Processing Policies for a Diaspora-Care health Insurance Programme provide otherwise, Practitioners may bill enrollees for non-covered services at Practitioners’s regular fees.
6. Practitioners agree to file all claims for services performed for Diaspora-Care health Insurance Programme program enrollees, and to submit such claims on forms acceptable to D-CHIP or representative office. Claims may be submitted electronically with the prior approval of D-CHIP. Payment of claims for services will be issued directly to Practitioners.
7. Practitioners agree that the determination of whether any services performed by Practitioners for an enrollee are covered under a Diaspora-Care health Insurance Programme. Practitioners also agree to furnish any information that is deemed necessary to make a coverage determination or to pay a claim. Practitioners shall have the opportunity to appeal any adverse coverage determination to D-CHIP.
8. Practitioners agree to maintain complete records related to treatment, billing and charges for enrollees of Diaspora-Care health Insurance Programme and, upon reasonable notice, to permit representatives of D-CHIP and any JANERO Consultancy, or their designees, access to all such records.
9. Practitioners agree to cooperate with peer review committees or medical consultants for the purpose of reviewing the adequacy of care provided under the Diaspora-Care health Insurance Programme, including in-office quality assessment audits. Practitioners agree to cooperate with the administration of any grievance procedure conducted as a result of a complaint against Practitioners by a Diaspora-Care health Insurance Programme enrollee.
10. Practitioners acknowledges and agree that D-CHIP neither underwrites nor administers the Health Insurance Programme or any other Diaspora-Care health Insurance Programme. Any underwriting or administration of such programs is the responsibility of JANERO Consultancy. D-CHIP’s responsibility is limited to establishing a medical provider network for use by JANERO Consultancy. Accordingly, Practitioners shall not only look to D-CHIP for payment of any kind but also to answer questions and provide assistance with respect to eligibility, claims payment, benefits structure and other program requirements.
11. This Agreement shall become effective when Practitioners receives a Diaspora-Care health Insurance Programme welcome kit signaling D-CHIP’s acceptance of this completed Agreement, and will continue until terminated by either party upon a ninety (90) day prior written notice. However, D-CHIP may terminate this Agreement immediately at any time if:
Practitioners fail to comply with the terms of this Agreement;
- Practitioners’ license is forfeited, limited, suspended, revoked, surrendered or not renewed;
- Practitioners are convicted of a felony or misdemeanor involving moral turpitude;
- Practitioner’s participation agreement with D-CHIP is involuntarily terminated; or their designee, determines that Practitioners are performing services in a manner which is detrimental to the health of Diaspora-Care health Insurance Programme enrollees.
12. Practitioners will accept payment for the completion of any single procedure begun before termination according to the payment terms stated in paragraph 4 of this Agreement. For a period of one year following termination of this Agreement for any reason, Practitioners agree to advise any patients who are Diaspora-Care health Insurance Programme enrollees that Practitioners are no longer participating as a Diaspora-Care health Insurance Programme Practitioners.
13. This Agreement is not assignable by Practitioners. This Agreement is assignable by D-CHIP to any parent, subsidiary, affiliate or successor entity.
14. This Agreement may be amended by D-CHIP upon written notice to Practitioners.
This Participating Practitioners Agreement, with respect to the Health Insurance Programme, is entered into for the provision of services under Department of health in the applied countries. The following three clauses are therefore required by law to be incorporated into this Agreement:
Each Practitioner who wishes to participate must complete an agreement for each location that will participate. Agreements must be signed and dated by the applying Practitioners before accepted by D-CHIP.