INTERNAL MEDICINE ASSOCIATES, PLLC

DOUGLAS L. DUVEL, M.D., ROBERT S. GOLDEN, M.D., APRIL HADSAITONG, M.D., ASIM HAMEEDUDDIN, M.D., MICHAEL Y. LEE, M.D., JENNIFER L. LUNDGREN, M.D., JASON S. MATHIAS, M.D., GABRIELLE NAVON, M.D., MARY BETH RICHMOND, M.D.

I have engaged Internal Medicine Associates, PLLC (the “Practice”) to provide non-covered, extended access to internal medicine services to me for a period of one year beginning on July 1, 2024, and understand that a yearly fee (“Annual Fee”) is assessed to pay for these non-covered services, amenities and benefits. As used in this Agreement, the term “Service Year” refers to the 1-year period beginning on July 1, 2024, as well as every 1-year period after that.

We will continue to provide these services that currently are not covered by insurance plans:

• Long appointment times
• Phone calls and MyChart messages of a medical nature will be answered by doctors, not nurses, nurse practitioners or physician assistants
• Short waiting room times
• Access to a doctor by phone on evenings, weekends and off-hours in urgent situations
• In-Person or telehealth appointments within 1-3 days, in urgent situations (however, in an emergency call 911)

This Annual Fee does not cover any services other than those described above. This program does not replace insurance and you should continue your current insurance coverage. The Annual Fee is not covered by any insurance program or by Medicare. Your current insurance will continue to be billed for services that it covers.