gammaCARE™ Terms and Conditions
Please make sure you have read and agree with the Terms and Conditions
PARTNERS FOR COVERAGE
This offer is valid for commercially-insured patients 18 years or older, are new to therapy and who have experienced a denial or a delay in insurance coverage determination. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. If at any time patient begins receiving reimbursement under any federal or state healthcare program, patient will no longer be eligible for this offer. Partners for Coverage provides a 31-day supply of gammaCore at no charge for eligible patients who have a valid on-label prescription and who have experienced a denial in health plan coverage, a requirement for a prior authorization or delay in a health plan coverage determination of at least 5 business days. If the insurer makes an unfavorable coverage decision, then patients may be eligible for an additional 11 months of therapy during such time as an appeal is being pursued. Once insurance approval is obtained, the patient is no longer eligible for this program. Partners for Coverage is not available to patients whose insurers have made a final determination to deny the patient coverage for gammaCore. By participating in this offer, patient agrees to promptly pursue and to continue to pursue during the program insurance coverage for gammaCore with his or her health insurance provider.
Offer good only in the USA, including Puerto Rico, at participating pharmacies. Void if prohibited by law, taxed, or restricted. Not available to residents of Massachusetts. There is no purchase obligation by virtue of a patient’s participation in the Partner for Coverage program. The selling, purchasing, trading, or counterfeiting of this offer is prohibited by law. This offer is not insurance and product received through this program cannot be submitted for reimbursement under any healthcare program. This offer cannot be combined with any other rebate/offer, free trial or similar offer for the specified prescription. By redeeming this offer, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
gammaCARE CO-PAY ASSISTANCE PROGRAM
TERMS AND CONDITIONS: 1. This offer is valid for commercially-insured as well as cash paying patients and is good for use only with a gammaCore Sapphire or gammaCore-S prescription at the time the prescription is filled. 2. Cash-paying patients and, depending on your insurance coverage, eligible insured patients will receive up to $300 of assistance for their out of pocket costs on the first month of treatment prescribed with a gammaCore Sapphire or gammaCore-S device, and up to $250 for 11 subsequent months of treatment. Check with your pharmacist or healthcare provider for your copay discount. Patient out-of-pocket expense may vary. 3. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs, including a state medical or pharmaceutical assistance program, or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescriptions or if you are covered by insurance in states that have an all-payer anti-kickback law or insurance that is paying the entire cost of the prescription. 4. Patients may not participate in this offer while enrolled in Partners for Coverage or while receiving any additional co-pay assistance or charitable organization support for gammaCore. 5. Each offer is valid for 12 months of gammaCore Sapphire or gammaCore-S prescription treatment. An explanation of benefits statement must be faxed in before each use to verify the benefit needed. 6. Offer only valid for patients 18 or over. 7. Limit of 1 card per patient. 8. electroCore reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers. 10. Offer void in Massachusetts. 11. Void if prohibited by law, taxed, or restricted. 12. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited. 13. This card is not insurance. 14. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
gammaCARE TEXT SUPPORT PROGRAM
As a participant in this program:
- I certify that I am over 18 years of age and a resident of the United States.
- I agree to (1) receive text and/or email messages related to the condition indicated on my Enrollment Form for 3 months, until I reply STOP, or the gammaCARE Support Program is otherwise discontinued; and (2) complete and submit online and/or mobile program survey(s).
This program is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services. Medical information provided by electroCore, Inc. and Gold Group Enterprises, Inc. dba GoMo Health (GoMo Health) is for informational and educational purposes only. After reading content or web pages, you are encouraged to review the information carefully with your provider. Never disregard professional medical advice, delay in seeking treatment, or rely on the information contained in this program in place of seeking professional medical advice. The information sent through text should not be considered as a medical consultation, nor is it meant to replace the provider’s decisions about the appropriateness or risks of a procedure given to a patient. If you think you may have a medical emergency, call your provider or 911 immediately.
Medical information changes constantly. electroCore, Inc. and GoMo Health do not guarantee the accuracy, adequacy, timeliness or completeness of any of the information on this site or on the linked websites and are not responsible for any errors, omissions, or any consequences arising from the use of the information contained at this or any linked website.
References to any entity, product, service or source of information not related to electroCore, Inc. and GoMo Health should not be considered an endorsement, either direct or implied, by electroCore, Inc. or GoMo Health. electroCore, Inc. and GoMo Health do not recommend or endorse any specific tests, products, procedures, opinions or other information that may be provided on any linked websites. The linked websites may contain text, graphics, images or information that you find offensive. electroCore, Inc. and GoMo Health have no control over and accept no responsibility for such materials.
We hope that you find this program useful in providing information about certain conditions and helpful in making your own health care decisions.
Health Safety Procedures
I understand and acknowledge that this program is not a substitute for receiving proper provider care and following my provider prescribed care plan, but as a supplemental approach to better managing my condition.
I understand that GoMo Health will collect information, including my personal health information, and I consent to the collection and usage of such information for the purposes described in these Terms and Conditions. I agree to waive my right to health care information privacy for use within this program and to share my information, including personal health information.
GoMo Health and electroCore, Inc. respect your privacy. electroCore, Inc. has engaged GoMo Health to provide the gammaCARE Support Program, a software platform with educational content that is available via a web link in a care message via text.
Information GoMo Health Collects
GoMo Health collects participant information submitted to this program in their Enrollment Forms and survey responses. This may include phone numbers, first and last name, medical condition, or course of treatment. When a participant sends a text or email message with program-specific data, his/her mobile phone number and/or e-mail address, the full content of the message, attached files, or other information provided may be recorded by GoMo Health.
In addition we may gather information about you automatically through the use of the https://gc.gomocompanion.com (Site), your IP address and how you navigate our Site. See also, the Section below on Information Collected via Technology.
Participants may indicate their preference to stop receiving communications or opt-out at any time. (See Your Choices Regarding Your Personal Information).
Use and Disclosure of Information
In general, participant information may be used for the following purposes: to enable participant access to program services; to personalize the content provided by the program; to inform future outreach activities; to improve program performance.
GoMo Health may provide participant information in a de-identified and aggregated form to electroCore, Inc. for the purposes of assessing the performance of the gammaCARE Support Program, understanding participant preferences, and conducting customer service analytics. Such information cannot reasonably be re-associated or connected with you.
We may, when required, provide participant information to third-party service providers or affiliates who work on our behalf, to provide the relevant program services. Examples of such services include sending texts, analyzing data, and providing customer service. If you do not want GoMo Health to use or disclose your information as described above, you may choose to not participate in the program. We may, when required, obtain information from third parties, including obtaining relevant prescription information from Asembia or its affiliates for those participants who choose to receive refill reminder communications.
The program uses Google Analytics to analyze how visitors interact with our Site. This service provides non-personally identifiable data including but not limited to data on where visitors came from, what actions they took on our Site and where visitors went when they left our Site.
The program may disclose personal information if it is believed in good faith that such disclosure is necessary to; (a) comply with relevant laws or to respond to subpoenas or warrants served on us; or (b) to protect and defend our rights, property, or you the participant. You hereby consent to us sharing your personal information under the circumstances described herein.
Information Collected Via Technology
We use technical, administrative and procedural measures in an attempt to safeguard your information from unauthorized access or use. No such measure is ever 100% effective, so we do not guarantee that your personal information will be secure from theft, loss, or unauthorized access or use.
GoMo Health uses industry-leading Secure Sockets Layer (SSL) technology for our Site to keep your personal information as secure as possible.
I understand that text is not considered a secure technology and that the messages I receive may indicate the nature of my condition. Beyond the nature of my condition, GoMo Health will not send information about my health via text as part of this program.
We will retain your information for as long as you are a participant in the program unless there is a legal obligation to which we are subject, or in light of our legal position it is advisable to retain your information.
California “Do Not Track” disclosure
California law (CalOPPA) requires GoMo Health to let you know how we respond to web browser “Do Not Track (DNT) signals.” Because there currently is not an industry or legal standard for recognizing or honoring DNT signals, we do not honor Do Not Track requests at this time.
Your Choices Regarding Your Personal Information
This program offers choices to participants regarding the collection, use and sharing of their information, including personal health information. Participants have a right at any time to opt out of the program, which will discontinue program contact and remove your information from the program database, by replying “STOP” at any time after receiving a text message. Participants may also contact GoMo Health directly, via email, at firstname.lastname@example.org.