Membership auto-renewal and cancellation rules for practices: ROSCA, the FTC rule and a cancel path that works

A monthly membership that keeps billing until the patient cancels is a negative option, in the legal sense of the term. That covers a concierge or direct primary care fee, a dental savings membership, a med spa monthly plan, a wellness subscription and an annual plan that renews on its own. The federal rules on these offers changed twice in two years, and summaries written in 2024 still circulate describing rules that are no longer in force. This guide sets out what the federal law says as of our check date, what a practice should show before it takes a card, how consent should be collected, and how to build a cancellation path that a patient can actually use.

Several related topics have their own guides and are not repeated here. How to explain that a membership is not insurance, and how to word savings and free claims for a dental plan, are in our guide to dental membership plan advertising. Access promises, Medicare patients and the opt-out question for retainer practices are in our concierge medicine marketing guide and our direct primary care marketing guide. Prepaid packages and gift cards are covered in our med spa gift card guide. For introductory rates with deadlines, see our guide to countdown timers and limited-time offers. Free trials of products that roll into a subscription are covered in our guide to free samples and trial offers for health products.

What counts as a negative option

The Restore Online Shoppers’ Confidence Act, known as ROSCA, borrows its definition from the Telemarketing Sales Rule. Under 16 CFR 310.2, a negative option feature is a provision in an offer or agreement to sell or provide goods or services under which the customer’s silence or failure to take an affirmative action to reject the goods or services, or to cancel the agreement, is interpreted by the seller as acceptance of the offer.

Put plainly, if the patient has to do something to stop the next charge, the offer has a negative option feature. In a practice, that includes:

• A monthly membership fee that is charged until the patient cancels.
• A yearly plan that renews and charges again on its anniversary unless the patient opts out.
• A first month free, or a reduced first month, that turns into a full monthly charge.
• A product subscription, such as skin care or supplements shipped on a schedule, sold alongside care.

A plan the patient pays once, for a fixed period, with no charge at the end unless they choose to buy again, does not have that feature. If your plan can be built that way, the rest of this guide matters less. If it renews on its own, it applies in full.

Where the federal rules stand

ROSCA is in force. Under 15 U.S.C. 8403, it is unlawful to charge or attempt to charge a consumer for goods or services sold in a transaction effected on the internet through a negative option feature unless the seller does three things: provides text that clearly and conspicuously discloses all material terms of the transaction before obtaining the consumer’s billing information, obtains the consumer’s express informed consent before charging the consumer’s card or account, and provides simple mechanisms for the consumer to stop recurring charges. Under 15 U.S.C. 8404, a violation is treated as a violation of a rule under section 18 of the FTC Act regarding unfair or deceptive acts or practices, and the FTC enforces it.

The 2024 amendments to the FTC Negative Option Rule are not in force. The FTC amended its Negative Option Rule in October 2024. According to the FTC’s own notice of March 13, 2026, on July 8, 2025 the United States Court of Appeals for the Eighth Circuit vacated the amended rule, holding that the Commission had failed to conduct the preliminary regulatory analysis required under section 22 of the FTC Act. The case is Custom Communications, Inc. v. FTC, 142 F.4th 1060 (8th Cir. 2025).

The older rule was restored, and it is narrow. In a final rule published February 12, 2026, effective the same day, the FTC restored the text of the Negative Option Rule as it existed before the 2024 amendments took effect. The FTC’s March 2026 notice says the restored rule applies only to prenotification plans for the sale of goods. A practice membership billed monthly for services is not that kind of plan.

A new rulemaking has started and has not finished. In the same March 13, 2026 notice, the FTC asked for public comment on amending the rule to help consumers avoid recurring payments they did not intend and to cancel without unwarranted obstacles. Comments closed on April 13, 2026. When we checked the Federal Register on October 30, 2026, we found no proposed or final rule from that proceeding. If one is published, this section will change.

Two practical points follow. First, a web page or a vendor checklist that describes the 2024 click-to-cancel requirements as current federal law is out of date, so do not copy its wording into your terms. Second, ROSCA’s three requirements, the FTC Act’s ban on deceptive practices and the automatic renewal laws set state by state still apply, and between them they cover the same ground a practice cares about: clear terms, real consent and an easy way out.

What to show before the patient enters card details

ROSCA requires the material terms to be disclosed clearly and conspicuously before the seller obtains the billing information. The FTC’s March 2026 notice lists the basic requirements the FTC has applied to negative option marketing under section 5 of the FTC Act. They start with disclosing the material terms, including at a minimum the existence of the negative option offer, the offer’s total cost, the transfer of the consumer’s billing information to a third party if that happens, and how to cancel.

For a practice membership, the sign-up page should show these on the same screen as the payment step, not behind a link to the full terms:

• That it renews. State that the membership renews automatically and charges the card on file until cancelled.
• The amount and the schedule. The fee, the billing frequency, the date of the first charge and the date of each later charge.
• Any minimum term. If the patient agrees to a set number of months, or owes a fee for leaving early, say so here and give the amount.
• What happens after an introductory price. If the first month is free or reduced, the date the full price starts and the full price.
• What the fee covers and what it does not. List included visits or services, and say which services cost extra.
• Unused visits or credits. Whether they roll over, expire or are lost on cancellation.
• Who bills the card. If an outside billing company charges the card, name that role so the patient recognizes the charge.
• How to cancel. The method, by when a request must arrive to stop the next charge, and when access ends.
• Refunds. Whether any part of a fee is refunded on cancellation, stated as your written terms say it.

Then make the advertising match. A homepage banner that says “$0 to start” while the first full charge comes in 30 days is a claim about cost. Under 15 U.S.C. 45 and 52, advertising must not be deceptive, and the FTC Policy Statement on Deception looks at whether a representation or omission is likely to mislead a consumer acting reasonably in the circumstances and whether it is material. A recurring charge is the kind of fact a patient would want before they sign up.

Getting consent that holds up

ROSCA requires the consumer’s express informed consent before the charge. The FTC’s list of section 5 requirements adds that the material terms must be disclosed before consumers agree to the purchase, and that marketers must obtain consumers’ consent to the negative option offer.

The statute does not prescribe a button design. These are the steps we build into membership sign-up flows, as our practice, not as quoted law:

• A separate checkbox or button for the automatic renewal, not pre-checked and not combined with agreeing to privacy terms or office policies.
• The renewal sentence placed next to that checkbox, in the same size type as the rest of the form.
• A confirmation email or text after sign-up that repeats the fee, the schedule, the next charge date and how to cancel.
• A stored record of what the patient saw and agreed to, with the date, so the practice can show it later.

Keep the confirmation message about billing. A membership receipt does not need to name the treatment the patient came in for, and leaving it out keeps clinical details out of an inbox someone else may read.

Front desk, phone and paper sign-ups

ROSCA applies to transactions effected on the internet. A patient who signs up on a tablet at the front desk through your online form is still in an internet transaction, so treat that flow the same way. A patient who signs a paper form is outside ROSCA’s wording, but not outside the FTC Act. The FTC’s March 2026 notice describes its section 5 requirements for negative option marketing without limiting them to online sales, and the automatic renewal laws set state by state may reach offline sign-ups too.

If the membership draws from a patient’s bank account, the Electronic Fund Transfer Act adds its own rule. Under 15 U.S.C. 1693e, a preauthorized electronic fund transfer from a consumer’s account may be authorized by the consumer only in writing, and a copy of the authorization must be provided to the consumer when made. Give the patient a copy of what they signed or agreed to, every time.

For the front desk, a short script keeps the spoken version consistent with the written one. Staff say the fee, how it is charged, that it renews until cancelled and how to cancel, then hand over or send the written terms before the card is run.

A cancellation path a patient can use

ROSCA requires simple mechanisms for a consumer to stop recurring charges. The last of the FTC’s section 5 requirements says marketers must not impede the effective operation of promised cancellation procedures, and should honor cancellation requests that comply with those procedures. Our guide to dark patterns on healthcare websites covers cancel paths alongside the other patterns in the FTC staff report.

Neither source sets out a design, so here is the one we recommend for a practice:

• Cancel the way they joined. If a patient can join online, they can cancel online, from their account or from a link in the confirmation message, without a call.
• A phone option that works. If you offer phone cancellation, answer it during the hours you list, and have every staff member who answers know how to process it.
• No hidden requirement. Do not require a reason, a visit, a letter or a notarized form to cancel unless your disclosed terms said so and the requirement is lawful in your state.
• An offer, not a wall. If you want to mention a pause or a lower tier, do it once, and let the patient decline and finish cancelling in the same session.
• Written confirmation. Send a confirmation that states the cancellation date, the date of any last charge and the date access ends.
• Stop the charge. Check that the billing system has actually stopped the recurring charge, including at any outside billing company.

Cancellation also has a care side. A patient who cancels a primary care or concierge membership still needs a way to get their records and to know who to call for follow-up. Tell them how to request their records, and do not make that request part of the cancellation steps.

Renewal reminders and price changes

An annual plan charges once a year, and a patient who joined eleven months ago may have forgotten the date. Whether a notice is required before a renewal or after a free trial, and what it must say and when, is set state by state, so check with counsel for the states where your members live. As a practice, we send a reminder before every annual renewal whether or not a state requires it, with the amount, the date and the cancel link.

A price increase changes a material term. Tell members before the new price is charged, give the new amount and the date it starts, and include the cancel link in the same message. Whether existing members need to agree again to the new price is a question for counsel under your terms and your state’s law.

Membership claims that need care

Sign-up pages can carry claims about what the membership gets the patient: same-day visits, a direct line to the doctor, savings compared with paying per visit. Each of those is an objective claim. The FTC Policy Statement Regarding Advertising Substantiation says advertisers need a reasonable basis for objective claims before they make them. If you advertise same-day appointments, have the schedule that supports it. If you advertise savings, compare against the prices non-members actually pay, as our dental membership guide explains.

Unlimited is a claim too. If a plan says unlimited visits but caps them by policy, or excludes certain visit types, the cap or exclusion is a material term and belongs next to the word.

Illustration: one sign-up page and one cancellation

Illustration: a family practice offers a monthly membership for patients without coverage. The sign-up page shows the monthly fee, that the first charge is today and each later charge falls on the same date each month, that the membership renews until cancelled, which visits are included and which services cost extra, and that members can cancel at any time from their account or by phone during listed hours, with access through the end of the paid month. A separate, unchecked box reads “I agree that my card will be charged this amount every month until I cancel.” The confirmation email repeats those terms and includes a cancel link.

Illustration: four months later a member clicks the cancel link. The page offers a pause option once, the member declines, and the cancellation completes on the same screen. The confirmation email gives the date access ends, says no further charges will be made, and explains how to request a copy of their records. The front desk checks the billing system that afternoon and confirms the recurring charge is off.

Checklist

• Every renewing membership is identified as a negative option offer, including annual plans and introductory months.
• Your terms and pages do not describe the vacated 2024 rule as current law.
• The sign-up page shows renewal, amount, schedule, minimum term, introductory price change, inclusions, unused credits, billing company, cancellation method and refunds before the card field.
• Advertising for the membership matches the sign-up terms.
• Consent to renewal is a separate, unchecked action, and a record of it is stored with the date.
• A confirmation message repeats the terms and the cancel method, without clinical details.
• Front desk and paper sign-ups use a script and give the patient a copy of the terms.
• Bank account debits have a written authorization with a copy to the patient, per 15 U.S.C. 1693e.
• Patients who join online can cancel online, and phone cancellation is answered during listed hours.
• Cancellations get written confirmation, and the recurring charge is checked as stopped.
• Annual renewals and price increases get advance notice with the cancel link.
• State automatic renewal laws for the states where members live have been reviewed with counsel.
• Access, savings and unlimited claims have support before they are published.

Points, punch cards and referral or review rewards raise separate questions; see our guide to patient rewards program rules.

Enrollment and administrative fees on a membership raise a separate question under state all-in pricing laws. See our guide to advertised prices and hidden fees.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices and health businesses. For a membership practice, that means a website sign-up page that shows the renewal terms before the card field, a separate consent step, confirmation and reminder messages, an online cancel path that matches the way patients join, and inquiry flows that route billing and cancellation questions to the right person. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. We do not sell lead lists and we do not pay for referrals. For the wider rules, see our healthcare marketing rules hub.

Sources

• 15 U.S.C. 8403: Negative option marketing on the Internet
• 15 U.S.C. 8404: Enforcement by Federal Trade Commission
• 16 CFR 310.2: Definitions (Telemarketing Sales Rule)
• FTC: Revision of the Negative Option Rule, final rule, 91 FR 6507 (February 12, 2026)
• FTC: Rule Concerning the Use of Prenotification Negative Option Plans, advance notice, 91 FR 12318 (March 13, 2026)
• 15 U.S.C. 1693e: Preauthorized transfers
• 15 U.S.C. 45: Unfair methods of competition and unfair or deceptive acts or practices
• 15 U.S.C. 52: Dissemination of false advertisements
• FTC Policy Statement on Deception
• FTC Policy Statement Regarding Advertising Substantiation

More in Cash-pay, aesthetic and wellness care