FORMS -  ECS Membership Registration

ECS Membership Registration Form

You are electing to electronically sign up for ECS Discount Medical Plan. Membership terms are listed below. To register, please take the time to read the information listed below regarding the membership terms and then agree to become and ECS member by entering the payment information at the bottom of the page.

TERMS AND BENEFITS OF EFFICIENT CARE SOLUTIONS (ECS) MEMBERSHIP

 

Eligibility for benefits begins when membership fees are paid. This fee is assessed yearly, and membership is January thru December.  However, November and December registrations will receive a grace period and the membership will be good for the following calendar year (13-14 month membership.) Special offers may lengthen the time of the grace period. Efficient Care Solutions is the trade name for KDK Enterprises LLC which is a legal and recognized discount medical plan. Family membership is defined as your spouse and children living in your home or a full-time dependent student or any other legally defined family member living in the same household.

 

Your membership in ECS is an agreement that provides you access to a participating health care provider; legally allowing them to offer you discounted services as established by state and federal law. This discount often may be 25% or more off of the established clinic fee schedule. Certain procedures/items may be excluded if listed out specifically in the fee schedule on file by the provider with ECS.  This is not an indemnity insurance plan. ECS does not reimburse your provider for services provided. In addition, it cannot be used as payment for deductibles or insurance plan co-pays. By using ECS you are declaring that you choose to suspend the use of any health care insurance (excluding Medicare or other insurance plans that do not cover all services offered by the provider) you are currently enrolled in for use at this office and understand no charges will be billed to your health insurance for covered services while participating in the ECS Discount Medical Plan. You can choose at any time to suspend using your ECS membership and start using a traditional type of insurance plan (just not both at the same time.) To do this you need to declare it in written form at the office you are seeking care. You agree to allow ECS to communicate and share basic information with contracted providers for reasons related to your membership or registration. ECS will comply with all HIPAA regulations regarding your personal information.

 

This agreement will become void and will not be used in conjunction with a third-party payer, personal injury claim, worker’s compensation claim, or other arrangements between you and your provider.  Your membership will be suspended in the event of a third-party payer of any kind is chosen to be used.  You may choose to re-activate your membership with ECS when you again qualify (at a time that the third-party payer no longer is being used). Unused membership will not be eligible for pro-rated refunds. Payment for services is due to your doctor at the time services are rendered unless specifically stated by your provider otherwise. Your provider may assess a service charge if payment is not received at the time agreed upon by you and your provider.

 

All fees paid to ECS are strictly non-refundable after 30 days from signing up, except as provided by law. All refunds will incur a service charge ($5) for processing as by law. Your ECS membership entitles you to use any participating ECS provider which can be found at www.ecsplan.com You must present your current I.D. card if asked by an enrolled provider, or have your current membership verified by contacting ECS in order to be eligible for ECS discounts. The membership fee is a yearly fee (calendar year) and will be charged on your first visit in each calendar year when receiving care from a participating provider with ECS.

  

ECS does not evaluate or credential any provider or associated clinical setting for type or quality of treatment.  ECS is not responsible for any treatment rendered or outcome of care.  It is understood ECS is a legal way to access a more affordable fee rate and you, the patient, and your care provider make all decisions regarding your care.

I declare that I would like to enroll in the ECS program. I have read and understand the terms of this membership agreement as listed on this form. I understand this membership is not medical insurance, but contractually allows me to access a discounted fee schedule for the services I receive at this office and any office that is a member of the ECS program. Failure to abide by the terms of this agreement may result in termination of my membership.

By entering the payment at this square.com portal and completing my payment, I am agreeing to the contract listed above and the electronic submission of my payment and basic information should be considered my signature. I understand I am required to fill out all of the information and I will receive a membership card from the location I am signing up for ECS on the same day of registration and payment.

We Have Upgraded Our System So You No Longer Need To Fill Out This Page Please Have Your Patient Sign A Paper Form Membership Contract. Go Directly To The Square.com Portal. You May Use This QR Code To Directly Access Our Secure Square.com Page.

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ECS PAYMENT

 

 

 

Your credit card will show a payment to KDK

 

Enterprises DBA ECS Discount Medical Plan

If the link above does not work go to this website:

https://kdk-enterprises-dba-ecs-discount-medical-plan.square.site/