INDIVIDUAL/FAMILY SUBSCRIPTION PLAN AGREEMENTFamily Subscription Plan Agreement • October 21st, 2020 • Missouri
Contract Type FiledOctober 21st, 2020 JurisdictionThis Plan Agreement (“Agreement”) is entered into as of the day of , 20 , and effective on the day of , 20 , between You (“Plan Member” or “Patient”) and Spectrum Health Care and its Primary Health Clinic located at 1123 Wilkes Boulevard, Suite 100, Columbia, Missouri, 65201 (“Provider”) under which the Provider, or their covering Provider, will make certain health and wellness services, amenities, and enhanced services (“Services”) available to You which may not otherwise covered by commercial insurance, managed care, Medicare and/or other third party payers. By voluntarily entering into this Agreement and remitting the Plan Fee (as set forth below), You may participate in the Provider’s Wavelength Health Plan (“Plan”) for a period of twelve (12) months beginning on the Effective Date.