Ommpo Health Pool Plan – Coverage Terms of Service
Effective Date: November 10, 2025
These Coverage Terms of Service (“Terms”) apply exclusively to members enrolled in the Ommpo Health Pool Plan. By subscribing to the Pool Plan, you agree to comply with these Terms, which outline eligibility rules, coverage limits, reimbursement procedures, and household participation requirements.
The Pool Plan is a cash reimbursement membership, not insurance.
1. Overview of the Pool Plan
The Pool Plan allows a household to share one combined reimbursement pool for eligible urgent and emergency medical expenses. Coverage applies only to medically necessary visits and services as described in this document.
The Pool Plan is designed to help households reduce out-of-pocket unexpected care costs in a simple, accessible, and predictable way.
2. Household Eligibility and Participation
2.1. Who Can Be Included
The Pool Plan is limited to individuals who live at the same physical residential address as the primary member. Eligible participants include:
- Adults
- Minors
- Seniors
- Pets (when included in your tier)
2.2. Household Limit
To maintain cost integrity and prevent misuse:
- A maximum of four (4) human household members may be added to a single Pool Plan.
- Pets may be added according to the plan tier.
- Additional humans beyond the four-member limit require Ommpo approval or may incur an added household fee.
2.3. Address Verification
Ommpo may require documentation to confirm household residency, including:
- State-issued ID
- Utility bills
- Lease or mortgage statements
- Other proof of address
Failure to provide verification may result in suspension or removal from the plan.
2.4. Primary Member Responsibilities
The primary member:
- Manages all household participants
- Ensures all information provided is accurate
- Confirms that all household members reside at the same address
- Remains responsible for all claims submitted under the Pool Plan
3. Scope of Coverage
3.1. Eligible Expenses
The Pool Plan provides reimbursement for:
- Urgent care visits for non-life-threatening medical conditions
- Emergency medical care not requiring hospital admission
- Prescribed medications related to a covered urgent or emergency visit
- Eligible veterinary urgent/emergency care for pets included in the plan
Eligible services must be itemized, paid in full by the member at the time of care, and submitted with proper documentation.
3.2. Annual Pool Limit
All household members share one annual reimbursement pool based on the plan tier:
- Coverage is first-come, first-served
- Once the annual limit is reached, no further reimbursements will be issued until the next membership cycle
- The pool resets annually on the member’s renewal date
3.3. Ineligible Expenses
The Pool Plan does not reimburse for:
- Routine or preventive care
- Annual checkups, physicals, or vaccinations
- Elective or cosmetic procedures
- Ongoing treatment for chronic illnesses
- Hospital stays or inpatient care
- Non-prescription medications unless tied to a covered visit
- Behavioral, dental, or specialty care unless explicitly included
- Any pet exclusions listed in the Ommpo Pet Coverage Addendum
Ommpo Health is not insurance and does not replace traditional healthcare coverage.
4. Waiting Period
All new Pool Plan memberships are subject to a 30-day waiting period before reimbursement eligibility begins.
- Claims dated before the waiting period ends will not be reimbursed.
- Immediate access is still provided to wellness content, perks, partner benefits, and digital resources.
- Limited exceptions may be granted for verified emergencies at Ommpo's discretion.
5. Reimbursement Process
5.1. Submitting a Claim
To request reimbursement, the member must:
- Log into the Ommpo Health account
- Submit itemized medical or veterinary bills
- Provide proof of payment
- Provide any additional documentation Ommpo requests, including identity verification
Only licensed urgent care, emergency clinics, and veterinarians are accepted.
5.2. Review Timeline
- Claims are reviewed within 7–10 business days
- Members receive approval or denial via email
- Approved reimbursements are paid within 45 days
5.3. Payment
Reimbursements are sent to the primary member’s bank account and are applied to the shared annual pool.
5.4. Denials and Appeals
If a claim is denied:
- A written explanation will be provided
- Appeals may be submitted within 30 days with additional supporting documents
6. Fraud Prevention and Verification
Ommpo employs strict fraud-prevention measures to protect Pool Plan members and preserve program integrity.
Fraud includes, but is not limited to:
- Submitting altered or falsified invoices
- Listing non-residents as household members
- Using multiple addresses to enroll additional people
- Submitting duplicate or misrepresented claims
Consequences may include:
- Immediate account suspension
- Permanent removal from the program
- Denial of pending or future claims
- Recovery of improperly paid funds
- Potential referral to collections or law enforcement
Participation in the Pool Plan constitutes acceptance of these rules.
7. Membership Fees, Billing, and Refunds
7.1. Billing
Pool Plan subscriptions bill monthly. Successful payment is required to maintain active coverage.
7.2. No Refund Policy
All Pool Plan fees are non-refundable:
- No refunds after a charge has processed
- No partial or prorated refunds
- No refunds if a claim is submitted within the same billing cycle
- Cancellations apply to future billing only
Billing errors may be reviewed if reported within three (3) days.
8. Plan Modifications
Ommpo may modify pricing, features, or coverage limits with 30 days’ notice. If changes are not acceptable, members may cancel before the next billing period.
9. Limitations of Liability
Ommpo is not responsible for:
- Provider availability or medical outcomes
- Costs exceeding plan limits
- Denied claims due to ineligible services
- Delays caused by documentation issues or fraud review
The Pool Plan is a reimbursement membership, not insurance.
10. Privacy and Data Protection
Ommpo collects and uses data to:
- Process claims
- Verify household membership
- Prevent fraud
- Improve service quality
All data is handled per the Ommpo Privacy Policy.
11. Dispute Resolution
Disputes will be resolved through mediation or arbitration. Members waive the right to a jury trial or class action.
12. Contact Information
Ommpo Health Support
Email: support@ommpo.com
Phone: 855-847-7575
Website: www.OmmpoHealth.com
Acknowledgment and Acceptance
By subscribing to the Ommpo Health Pool Plan, you acknowledge that:
- You have read and understand these Terms
- You agree to comply with all household and verification requirements
- You understand the Pool Plan is not insurance
- You accept that Terms may be updated periodically
Continued use of the Pool Plan confirms your acceptance of any updated Terms.
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