To offer a direct primary care service, the primary care provider must obtain a completed direct primary care agreement for each patient obtaining direct primary care services. In order to be considered a direct primary care agreement for the purposes of this section, the direct primary care agreement must meet all of the following requirements:
Be in writing;
Be signed by the individual patient or his or her legal representative and be made available for the records of the primary care provider or agent of the primary care provider;
Allow either party to terminate the agreement on written notice to the other party;
Describe the scope of primary care services that are covered by the periodic fee;
Specify the periodic fee for ongoing care under the agreement;
Specify the duration of the agreement, any automatic renewal periods, and prohibit the prepayment of the agreement. Upon discontinuing the agreement, all unearned funds, as determined by the lesser of normal undiscounted fee-for-service charges that would have been billed in place of the agreement or the remainder of the membership contract, are returned to the patient. Upon termination of the agreement, the patient shall not be liable for the remainder of payment associated with the agreement or membership contract. However, the patient shall be responsible for the true cost of services rendered regardless of when the contract is terminated.
Prominently state in writing the following:
That the agreement is not health insurance;
That the agreement standing alone does not satisfy the health benefit requirements as established in the federal Affordable Care Act; and
That, without adequate insurance coverage in addition to this agreement, the patient may be subject to fines and penalties associated with the federal Affordable Care Act.