Ground Membership Terms and Conditions (Oregon)
City of Bend FireMed, Crescent RFPD, Blue Mountain Hospital Ambulance, Crook County Fire & Rescue, Harney District EMS, Klamath Falls District 1, Rocky Point and Chemult Rural Fire Protection District are voluntary ambulance membership programs operated by each individual agency, hereinafter referred to as FireMed.
- FireMed membership benefits include all persons who are permanent residents of the same single-family dwelling/ noncommercial residence living together as part of a family unit, but not to include roomers or boarders. Membership benefits are also extended to include household members living in substitute care (i.e. nursing homes) within your city and district ambulance service areas.
- The first person listed on the application form is designated as the “Primary Member.” Only those persons who meet the membership eligibility requirements AND are listed in the membership record at the time services are rendered are eligible for benefits.
- FireMed Membership is not an insurance policy but secondary to insurance carriers. All available insurances will be billed first. We will accept payment from insurance carriers as payment in full.
- I transfer directly to the FireMed agency my rights to ground medical insurance payments due to me. Such payments shall not exceed FireMed regular charges.
- Ground Memberships are honored by FireMed Membership programs of Oregon. Ground Membership covers ground ambulance charges only.
- Ground emergent medical transports are based on medical need, not membership status, and transport patients to the closest medically appropriate facility as requested by the physician. Non-emergency transports are not covered by this agreement.
- No refunds will be issued on membership purchases. Membership benefits are non-transferable.
- There is no grace period on the membership. Payment must be received by the due date to avoid lapse in benefits.
- New and lapsed membership benefits take effect 72 hours after receipt of completed enrollment with payment.
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ParaMed LifeCare Terms and Conditions
I hereby apply for membership in ParaMed LifeCare tor myself and eligible members who live at my address. I understand the enclosed fee provides emergency ambulance care and transportation within the Lower Umpqua Hospital Emergency Medical Service service area, including transport to Bay Area Hospital or Lower Umpqua Hospital and non-emergency and long distance ambulance service as noted below. Membership starts 15 days after the Company receives a complete application with full payment; however, the waiting period will be waived for unforeseen events occurring during such time. Members must be natural persons. Non-emergency ambulance service to hospitals, 24-hour emergency medical receiving facilities, nursing homes and adult foster care centers within 35 miles is covered when medically necessary as determined by a doctor and with prior authorization from your insurance company if required by them. Long distance transports of over 35 miles are not covered but will be considered to have 25% of the co-payment prepaid by this membership agreement. I understand that ParaMed LifeCare is not insurance but will provide ambulance service through the Lower Umpqua Hospital EMS and will bill whatever insurance or medical benefits I may have and is entitled to primary and secondary insurance payment. ParaMed LifeCare is in excess of any insurance or medical benefits which I may have. I further authorize the release of medical information for the purpose of ambulance insurance billing only. Should I or a family member receive payment from insurance or other medical benefits provider for ambulance service rendered by Lower Umpqua Hospital EMS, I will immediately forward such payment to Lower Umpqua Hospital. ParaMed LifeCare membership is not solicited from persons who receive welfare medical benefits and such membership constitutes a voluntary contribution only. I understand that violations of the terms of this agreement may result in immediate cancellation. This membership is non-refundable and non-transferable.
*DEFINITION OF FAMILY
LifeCare membership covers immediate family members living in the same household. The member, spouse, unmarried children under age 25 and other persons listed as legal dependents for income tax purposes are covered. Others not included in this definition are required to obtain their own separate membership.
MEMBER BENEFITS IN AREAS OUTSIDE OF LOCAL LIFECARE SERVICE AREA
Member benefits are extended to areas outside of the local LifeCare service area but within the State of Oregon. These benefits are limited to the terms of agreement in effect by each individual ParaMed or FireMed participating agency at the time benefits are used. Members who receive ambulance service from any other ParaMed or FireMed participating agency are eligible for benefits offered by that agency provided that: 1) a copy of the ambulance bill is submitted to the local ParaMed LifeCare within 30 days of receipt of bill, 2) the member agrees to abide by the participating agency’s terms of agreement. A current list of FireMed participating agencies is on file in the ParaMed LifeCare business office.
TO THE INSURANCE CARRIER
I authorize a copy of this agreement to be used in lieu of the original on file at the ParaMed LifeCare office. The original may be furnished on request. I authorize payment of insurance benefits for ambulance service for myself or family members directly to Lower Umpqua Hospital ParaMed, according to the LifeCare agreement and as itemized on the attached claims. I have paid the co-payment for ambulance service to be rendered and expect your usual and customary ambulance reimbursement on my behalf to be sent directly to the Lower Umpqua Hospital.