Application for Provider Participation

  • This agreement is made this day between Opticare Vision Services, a Utah Limited Health Plan, hereinafter referred to as Company, and

  • hereinto referred to as Provider, for the sole purpose of providing eyewear and vision care services to the policyholders of Opticare Vision Services.

    Both Provider and Company agree to the reimbursement schedule attached and reserve the right to review this schedule on an annual basis.

  • and shall continue for one year, automatically renewing for successive one-year periods unless terminated within the provisions of this agreement.

    2. License. Provider acknowledges that Provider will provide vision examinations only through those who hold valid licenses in the State of Utah for the practice of Optometry.

    3. Secrecy Covenant. The Provider acknowledges that materials and information, which Company deems confidential, are important to and greatly affect the Company in a competitive marketplace. Provider agrees, for the term of this agreement, to not use any information deemed confidential by Company, to any parties other than the Company.

    4. Company’s Use of Provider’s Participation. Provider agrees that the Company may use its name, address and the fact of provider participation in this agreement for purposed of publicizing Company’s network, preparing bids for contracts and other similar purposes.

    5. Termination. Company reserves the right to terminate this agreement, at its discretion, without cause by giving 60 days written notice to provider. Provider reserves the right to terminate this agreement with 60 days written notice if company fails to provide reimbursement, for products or services, under proper administration of Opticare Vision Services funded plans, within 60 days of correct billing date.

    6. Indemnification by Provider. Provider agrees to indemnify and hold harmless Opticare Vision Services, its Board of Directors, officers, agents, enrollees, associations and employers who hold contracts with Opticare Vision Services and its employees from any and all demands, claims, suits, liability, loss, damage expense of any kind, including costs of attorney fees, which result solely from negligent or willful acts or omissions of Provider, its employees or agents, regarding their duties and obligations under this agreement, including the duty to maintain applicable standard of care.

    7. Indemnification by Opticare Vision Services. Opticare Vision Services agrees to indemnify and hold harmless the Provider, its Board of Directors, officers, agents and employees from any and all demands, claims, suits, liability, loss, damage expense of any kind, including costs of attorney fees, which result solely from negligent or willful acts or omissions of Opticare Vision Services, its employees or agents, regarding their duties and obligations under this agreement, including the duty to maintain applicable standard of care.

    8. Limited Liability of Opticare Vision Services Enrollees. If Opticare Vision Services fails to pay for services set forth in this contract, the enrollee is not liable for any sums owed by the organization. Should the organization become insolvent:

    1. The rehabilitator or liquidator may require the provider to continue providing services under this contract until the earlier of 90 after the petition for rehabilitation or liquidation, or the date of the term of the contract ends. If rehabilitation or liquidation petition is filed, fees may be reduced to the provider from Opticare Vision Services for the same time period stated above.
    2. The organization may reduce the fees the participating provider is otherwise entitled to receive from the organization under the contract between the participating provider and the organization.

    If the conditions above are met, the provider shall:

    1. Accept reduced fee as payment in full and relinquish the right to collect any amounts from the insolvent organization’s enrollees.
    2. The liquidator may not reduce the fees to less than 75% of the contracted fees set forth in the provider agreement.
    3. The enrollee shall continue to pay the same co-pays, deductibles and other payments for services rendered from participating provider that enrollee was required to pay prior to:
      1. The petition for reorganization
      2. The petition for liquidation
    4. A participating provider may not collect or attempt to collect sums owed by the organization or the regular fee reduction

    9. Acknowledgement. By signing this agreement, both parties acknowledge that they have read this agreement, that they understand it and intend to fulfill each promise in it, and that they understand that this is a legally binding agreement. Both Provider and Opticare Vision Services have executed this agreement this day,

  • Authorized OfficerDate
  • Opticare Vision ServicesDate