Clinic shall provide services to a member from the effective date of the contract under the following terms and conditions:

1. Clinic may refuse, at its discretion, to provide, continue, extend or renew membership on general conditions to persons who have completed 60 years of age or have I, II, III (not working) group of disability.

2. Clinic reserves the right to require a member to consult a Clinic physician. The member agrees to authorize Clinic to release and obtain medical records.

3. The limitations and exclusions of the Health Care Plan are:

   1. Health care services are covered in full only if provided or arranged by a Clinic physician. 

   2. The Plan doesn’t cover chronic diseases treatment. The program covers only the exacerbations of chronic diseases.

   3. Clinic Health Care Plan does not cover the costs related to treatment of conditions requiring long term specialty care (such as extended care in a nursing home, hospice care, or home health care) or permanent outpatient follow up measures included, but not limited to cancer treatment, open heart surgery, kidney dialysis, organ transplantation, known CAD* (i.e. history of MI*), unstable angina, atrial fibrillation, CHF*, stroke, COPD*, restrictive or fibrotic lung disease, GI bleed, liver cirrhosis, chronic hepatitis, inflammatory bowel disease (Crohn’s, ulcerative colitis), chronic pancretitis, * type I, complicated DM* type II, prolactinoma, acromegaly, renal insufficiency, nephritis, polycystic kidney disease, SLE*, inherited or acquired, included HIV, HIV related diseases, Blood disorders, including coagulation system, rheumatoid arthritis;

   4. The Clinic Health Care Plan will not cover surgical procedures (except described in appendix B) in case of acute, chronic conditions (emergency or not) as well as the costs related to plastic, cosmetic, or re-constructive surgeryand prosthetics;

   5. Clinic Health Care Plan does not cover prenatal care and pregnancy related conditions (except for the Program «Future mother»);

   6. The Clinic Health Care Plan does not cover the costs related to diagnosis or treatment of infertility or any form of artificial insemination, or abortion carried out for non-medical reasons, Treatment of ectopic pregnacy, Contraception (IUD*), Surgical treatments (including but not limited to D&C*, hysterogram, hysteroscopy, biopsy);

   7. The Clinic Health Care Plan does not cover the costs related to hearing aids, eyeglasses, frames, lens, contact lens, prosthetics or radial keratotomy;

   8. The Clinic Health Care Plan does not cover the costs relating to accidents, injuries, traumas or diseases resulting from military service and due to alcohol or drug drunkennes;

   9. The Clinic Health Care Plan does not cover medications (prescribed or OTC, oral, IV, IM forms) except one-time cases during Doctor’s consultation or during home visit (except for the Program «Future mother»);

   10. The Clinic Health Care Plan will not cover the costs related to congenital diseases;

   11. The Clinic Health Care Plan will not cover the cost related to pre-existing neo-plastic diseases;

   12. The Clinic Health Care Plan will not cover the costs related to Dental care other than as stated in the Plan Structure section.

   13. Psychological consultations in excess of the Clinic Health Care Plan are available on a co-payment basis;

   14. The Clinic Health Care Plan will not cover costs related to procedures that are considered to be experimental by the Clinic medical director;

   15. The Clinic Health Care Plan shall not cover the costs of medical services, examinations, or consultations not authorized or performed by Clinic and/or treatments that, in Clinic’s judgment, are not medically necessary.

If the medical care for not covered by the Plan conditions is required the patient may get these conditions treatment at the Clinic on a co-payment basis.

Also Clinic can provide all necessary medical records (on patient’s permission) for follow up treatment in special hospitals.

Before the first visit to the Clinic Doctor the member fills in the “Pre-existing questionnaire”.

All the abovementioned limitations become valid only after each separate case is considered by the council of Clinic doctors.

Clinic shall not be liable for damages to health, death or losses suffered by a member due to the fact that Clinic assistance was delayed, suspended or impeded for reasons of Force Majeure or any other reason beyond Clinic’s reasonable control. The above-mentioned circumstances do not authorize Clinic to resign from their attempts to provide services.

*COPD=chronic obstructive pulmonary disease  *CAD=coronary disease *BCP=birth control pills  *IUD=intrauterine device *D&C=dilatation and curettage

*HTN=hypertension *DM=diabetes mellitus *CHF=congestive heart failure *SLE=systemic lupus erythematosis *MI=myocardial infarct