If the Primary Member moves to a different residence, wishes to add or remove an Additional Member or would like to make another update to his/her membership information, the Primary Member must make the change via the on-line portal or by calling the telephone number provided by the City. A change to add an Additional Member is not effective and Program benefits are not available to any Additional Member(s) added until after the Primary Member provides all required information for each person, pays any additional amount due, the requested change is processed and the update is reflected in the Primary Member's subscription account.

A notice to renew Program subscription will be emailed approximately one (1) month prior to the subscription expiration date. Primary Members without an email address will receive notification via the US Postal Service. If the Primary Member does not receive a notice at least two weeks before the subscription expires, please contact the HFD-EMS Subscription Program at HFD-EMS@cityofhenderson.com.

To renew a subscription, the Primary Member must submit a complete application through the on-line portal, agree to the Program terms and conditions by electronically signing the then-current Ambulance Subscription Program Agreement and submit full payment of the subscription fee to the City. If the Primary Member renews his/her subscription before it lapses, the subscription will be valid for one year from the subscription anniversary date. Otherwise, a subscription renewed after expiration is valid for one (1) year from the effective date of subscription renewal, and that effective date occurs when the renewal application is processed and full payment is received by the City.

Program subscription fees are non-transferrable and non-refundable.

Program terms and conditions, benefits and fees are subject to change at the time of subscription renewal at the City's discretion.

PAYMENT FOR EMERGENCY MEDICAL TRANSPORTATION

The Program is not an insurance policy. When HFD provides emergency transportation to a Covered Member, the City will bill either his/her health insurance plan or the Covered Member if he/she does not have insurance at the time of the incident.

Payment of the subscription fee constitutes the Covered Member's authorization for the City to charge, to the extent available, all health insurance, Medicare and other coverage for emergency medical transportation.

If the Covered Member's health insurance pays the City's bill for services, the City will write off the amount the Covered Member is responsible for paying as a co-payment.

If a Covered Member has health insurance at the time of the incident but refuses to provide the information, or does not provide it in a timely or complete manner, the Covered Member will receive a twenty percent (20%) reduction on the bill and will be responsible for one-hundred percent (100%) of the adjusted balance even if the Covered Member later provides that health insurance information.

If the Covered Member's health insurer sends the payment for the City's services to the Covered Member or another person on the Covered Member's behalf instead of the City, the Program member must immediately remit to the City the amount of that payment.

The Covered Member must notify the City if the incident involves workers' compensation or was caused by a third-party and if the Covered Member is represented by an attorney in connection with the incident.

If a Covered Member receives a financial settlement or judgment that covers the ambulance transport or if workers' compensation covers the City's services, the Program benefits that reduce the City's bill are not available to the Covered Member and the total amount billed by the City is due and owed to the City by the Covered Member.

CITY EMPLOYEES

If a full-time City employee wishes to enroll as a Primary Member and have the subscription fee deducted from his/her paycheck, the above Program terms and conditions are modified as follows:

a.                  Instead of paying the subscription fee upfront for the annual subscription, the City employee may have the fee divided by 26 and deducted from his/her bi-weekly paycheck.

b.                  The City employee must also provide his/her employee identification number on a subscription application.

c.                   The subscription is effective as of the date that the Primary Member submits a complete application through the on-line portal, the Primary Member agrees to the Program terms and conditions by signing the then-current Ambulance Subscription Program Agreement, that application is processed and the first payment of the subscription fee is deducted from the City employee's paycheck.

d.                  If the City employee's employment is terminated before the entire annual subscription fee is deducted for his/her subscription, the City will deduct the balance due from his/her last paycheck.

Subscription Agreement

Ambulance Subscription Program Agreement

This Ambulance Subscription Program Agreement ("Agreement") is between the City of Henderson, a municipal corporation and political subdivision of the State of Nevada, on behalf of its Fire Department (the "City") and TBD, a natural person, (the "Primary Member") residing at TBD , individually a "Party" and collectively the "Parties".

1.                   Not Insurance. Primary Member understands that City's ambulance subscription program, referred to as the HFD-EMS Subscription Program, (the "Program") is a voluntary subscription program, that CITY IS NOT AN INSURANCE PROVIDER, that THIS AGREEMENT IS NOT AN INSURANCE POLICY and that THIS AGREEMENT IS NOT A SUBSTITUTE FOR HEALTH INSURANCE.

2.                   Eligibility Certification. Primary Member certifies, as of the Effective Date, that she/he permanently resides in the United States of America (USA), is 18 years of age or older, does not have any outstanding bill due and owing for ground ambulance services provided by City through the Henderson Fire Department (HFD), is not covered by Medicaid and has not added any person as an Additional Member (defined below) who is covered by Medicaid or is covered by Nevada Check Up or another Children's Health Insurance Program. If any of the Primary Member's certifications is false or if (after the Effective Date) Primary Member no longer lawfully permanently resides in the USA, then no Covered Member (defined below) may receive Program benefits and the subscription will be deemed to have expired and the subscription fee forfeited. The Primary Member and any Additional Members are referred to as "Covered Members."

3.                   One-Year Subscription; Effective Date of Subscription; Agreement Termination. This Agreement is effective on the date City signs this Agreement. Primary Member's subscription in the Program is valid for one (1) year from the effective date of subscription and will expire automatically. The subscription is effective after all of the following events occur (on the date the last of these events occurs): (a) Primary Member submits a complete application for Program subscription through the on-line portal; (b) Primary Member signs this Agreement; (c) that application is processed; and (d) full payment of the subscription fee is received by City. City will provide electronic confirmation of the effective date of Primary Member's subscription. For example, if the effective date is January 19, the subscription will expire on January 31 at 11:59:59 pm of the following year. This Agreement shall terminate on the date Primary Member's subscription expires pursuant to this Section 2 or Section 3 or is cancelled by City pursuant to Section 4 or Section 8. Upon Agreement termination, no Covered Member may receive any Program benefits.

4.                   Cancellation of Program and Subscription. City reserves the right to stop operating the Program, cancel the Primary Member's subscription and refund a prorated portion of the Primary Member's enrollment fee based upon the unexpired subscription period if, in the opinion of the City's City Manager, the operation of this Program is no longer in the best interest of City. City will notify Primary Member at least thirty (30) days before canceling Primary Member's subscription and identify the date the cancellation is effective.

5.                   Subscription Fees and Plans. Program subscription fees are non-transferrable and non-refundable. There are three subscription plans, and Primary Member has selected the "TBD" Plan:

(A)               Individual Plan. The annual subscription fee is $59, and Primary Member is the only person included in the subscription. A Primary Member may only identify one residential location as his/her residence; and, if Primary Member resides in a multi-unit or apartment building, the residence is limited to the unit or apartment actually occupied by Primary Member.

(B)               Family Plan. The annual subscription fee is $99. Primary Member and up to five (5) additional natural persons who lawfully permanently reside in the same residence as the Primary Member (each such person, other than the Primary Member, is referred to as an "Additional Member") are included in the subscription.

(C)               Family Plus Plan. The annual subscription fee is $99 for the Primary Member and five Additional Members and $10 for each Additional Member above those six people. Primary Member, five Additional Members and an unlimited number of Additional Members (for an additional $10 for each Additional Member) are included in the subscription.

6.                   Additional Members. Primary Member shall not add any person as an Additional Member who is covered by Medicaid or by Nevada Check Up or another Children's Health Insurance Program. If Primary Member wishes to remove one or more Additional Members during the subscription period, Primary Member's subscription plan will remain the same and City will not refund any portion of the subscription fee. If Primary Member wishes to add one or more Additional Members during the subscription period, the following apply:

(A)               Change from Individual Plan to Family Plan or Family Plus Plan. If Primary Member selects the Individual Plan and during the subscription period wishes to add one or more Additional Members, Primary Member must request that his/her subscription be converted to the Family Plan or Family Plus Plan, as applicable, and pay the additional amount due for the subscription fee. City will not pro-rate the additional amount due. For example, if Primary Member wishes to add two Additional Members, Primary Member must pay $40, which is the additional amount due to change the subscription to a Family Plan. The change is not effective and Program benefits are not available to any of those Additional Members until after Primary Member provides all required information for each person, pays the additional amount due, the requested change is processed and the update is reflected in the Primary Member's subscription account.

(B)               Change from Family Plan to Family Plus Plan. If Primary Member selects the Family Plan (or an Individual Plan is converted to a Family Plan) and during the subscription period wishes to add one or more Additional Members that would cause the subscription to include more than five Additional Members, Primary Member must request that his/her subscription be converted to the Family Plus Plan and pay the additional amount due for the subscription fee. City will not pro-rate the additional amount due. For example, if Primary Member wishes to add three Additional Members and thereby have a total of eight Additional Members, Primary Member must pay $30, which is the additional amount due to add three people to a Family Plus Plan. The change is not effective and Program benefits are not available to any of those Additional Members until after Primary Member provides all required information for each person, pays the additional amount due, the requested change is processed and the update is reflected in the Primary Member's membership account.

7.                   Updating Membership Information. If Primary Member moves to a different residence or would like to make another update to his/her information, the Primary Member must make the change via the on-line portal or by calling the toll-free telephone number provided by City.

8.                   Financial Responsibility; Payments from Insurer. The Covered Member is financially responsible for the full cost of the ground ambulance transport provided by HFD and that obligation survives termination of this Agreement. However, if the conditions in Section 9(A) or Section 9(B), as applicable, are met, City will waive certain cost-sharing amounts or discount the amount owed in accordance with Section 9(A) or Section 9(B), as applicable. With respect to all ground ambulance transportation, the destination shall be governed by HFD's existing medical protocols. The Covered Member will be responsible for all costs incurred in connection with transportation to locations not covered by the Program. If a Covered Member's health insurer sends the payment for City's ambulance services to that Covered Member or another person on that Covered Member's behalf instead of City, that Covered Member must immediately remit to City the amount of that payment. If City does not receive the amount of that payment within 15 days of City's request, City may cancel Primary Member's subscription with five (5) days prior notice and will identify the date the cancellation is effective in that notice. City will then bill the Covered Member for the full cost of City's ambulance services.

9.                   Program Benefits. Program benefits are not available for a Covered Member until the subscription is effective, and no Program benefits are available for a Covered Member after the subscription expires. Subject to compliance with the terms and conditions in this Agreement, Program benefits for each Covered Member include:

(A)               Co-Payment Waived If Insurance. If the Covered Member transported has health insurance coverage at the time of the ambulance transport, then City will waive that Covered Member's insurance co-payment for up to two (2) ground ambulance transports per subscription year if all of the following conditions are met: (1) HFD is dispatched through the 9-1-1 system; (2) HFD transports that Covered Member; (3) the ground ambulance transport is Medically Necessary; (4) HFD transports that Covered Member from a location inside the City of Henderson's corporate boundaries to a local hospital in City of Henderson, unincorporated Clark County within the Las Vegas Valley, City of Las Vegas or City of Boulder City; (5) that Covered Member provides health insurance information in a timely and complete manner; (6) the Covered Member does not receive a financial settlement or judgment that covers the ambulance transport; and (7) worker's compensation does not cover the cost of the ambulance transport.

(B)               20% Reduction of City's Ground Ambulance Charges If No Insurance. If the Covered Member transported either does not have health insurance coverage at the time of the ambulance transport or does have health insurance and fails to provide his/her health insurance information to City in a timely and complete manner, then City will provide a twenty percent (20%) discount on that Covered Member's transport bill for up to two (2) ground ambulance transports per subscription year if all of the following conditions are met: (1) HFD is dispatched through the 9-1-1 system; (2) HFD transports that Covered Member; (3) the ground ambulance transport is Medically Necessary; (4) HFD transports that Covered Member from a location inside the City of Henderson's corporate boundaries to a local hospital in City of Henderson, unincorporated Clark County within the Las Vegas Valley, City of Las Vegas or City of Boulder City; (5) that Covered Member provides health insurance information in a timely and complete manner; (6) the Covered Member does not receive a financial settlement or judgment that covers the ambulance transport; and (7) workers' compensation does not cover the cost of the ambulance transport.

(C)               Adult and Pediatric First Aid/CPR/AED Class and Certification. Once every two years and only when the subscription is effective, a Covered Member may take an Adult and Pediatric First Aid/CPR/AED class offered by City at one of its recreation centers and, after successful completion of the course, receive a digital certificate for Adult and Pediatric First Aid/CPR/AED valid for two years.

(D)              Stop the Bleed Course. Once every two years and only when the subscription is effective, a Covered Member may take a "Stop the Bleed" course offered by City, in conjunction with the U.S. Department of Homeland Security, at one of City's recreation centers.

The City reserves the right to modify the content of a class, to add a minimum age requirement for a Covered Member to take a class and to establish policies concerning a class, such as requiring a Covered Member to leave a class if his/her behavior is unsafe or disruptive.

10.               Medically Necessary Services. Primary Member acknowledges and agrees that one condition for a Covered Member to receive the Program benefits described in Section 9(A) or Section 9(B) is that the Covered Member's use of City's ambulance services is Medically Necessary. "Medically Necessary" means the patient's condition is such that use of any method of transportation, other than a ground ambulance, is contraindicated and could not be used without endangering the patient's health. If it is determined that a Covered Member's use of City's ambulance services was not Medically Necessary, that Covered Member will be responsible for the full cost of City's ambulance services.

11.               HFD Ground Ambulance Services. As set forth in Section 9(A) or Section 9(B), Program benefits under those sections are not available for medical incidents that occur outside the City's corporate boundaries, the Program benefits do not cover air ambulance services or any ground ambulance services provided by someone other than HFD, such as Community Ambulance, Clark County or another ground ambulance provider who provides transport instead of HFD as a result of being dispatched through the 9-1-1 system. Moreover, City does not have any reciprocity agreements with any other cities or agencies regarding the Program benefits,

12.               Authorization to Release Information and Assignment of Benefits. Primary Member understands that the Program subscription is not an insurance plan and that City will bill for its services and receive payments from a Covered Member's insurer or third party (such as Medicare, Blue Cross, etc.). Primary Member, on behalf of Primary Member and each Additional Member, hereby (a) authorizes release to City, the Centers for Medicare Services or another third party of a Covered Member's medical information or other documentation, as City determines is necessary to file a claim with such an insurer or third party for City's ambulance services; (b) assigns all benefits otherwise payable to a Covered Member to City; (c) authorizes all benefits to be made directly payable to City; (d) requests that payment or authorized Medicare benefits be made on that Covered Member's behalf to City for any ambulance service provided to Covered Member by HFD; and (e) agrees to timely sign and deliver to City such authorizations and to timely provide such other documentation (such as a physician's certification that the transport was Medically Necessary) City requests to facilitate any of the foregoing.

13.               No Change in City's Obligation. Neither the Program nor this Agreement imposes an additional duty on City or HFD to provide individual or special ambulance services to a Covered Member. Primary Member understands and acknowledges that this Agreement does not create a special duty, change any general duty or alter the priority HFD establishes for a response to a request for service.

14.               Notices. All notices required by this Agreement shall be in writing and shall delivered by personal delivery, by a recognized courier, or by certified U.S. mail (postage prepaid, return receipt requested), and addressed to the receiving Party at the address below:

City:
City of Henderson
Attn: Fire Chief
240 S. Water Street, MSC 133
Henderson, NV 89015

Primary Member:

As identified in the preamble of this Agreement

Such notice will be deemed to have been received by the Party to whom it was addressed on the date of delivery (or attempted delivery) if delivered personally, on the date officially recorded as delivered (or delivery refused) according to the record of delivery if delivered by courier, or three (3) days after mailing. Neither Party shall refuse delivery of any notice hereunder. Either Party may change its contact information for purposes of the Agreement by giving written notice to the other Party in the manner set forth above.

15.               Waiver. No performance obligation in this Agreement or any breach thereof shall be deemed waived unless such waiver is in writing and signed by the Party claimed to have waived such performance obligation or breach. The failure of either Party to enforce any of the provisions of this Agreement at any time, or to require performance by the other Party of any of the provisions of this Agreement at any time, will not be a waiver of any provisions, nor in any way affect the validity of this Agreement, or the right of any Party to enforce each and every provision. No waiver of a breach of this Agreement shall constitute a waiver of or excuse any different or subsequent breach

16.               Assignment. Primary Member shall not assign, transfer, convey or otherwise dispose of this Agreement or his/her right, title, or interest in or to the same, or any part thereof, without prior written consent of City and any attempted assignment in violation hereof shall be void.

17.               Severability. If any provision in this Agreement shall be held to be invalid or unenforceable, the remaining provisions of this Agreement shall remain valid and binding on the Parties. Any invalid or unenforceable provision will be deemed severed from this Agreement, and the balance of this Agreement will be construed and enforced as if it did not contain that invalid or unenforceable provision. The Parties further agree to amend this Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision.

18.               Entire Agreement. This Agreement constitutes the complete agreement between the Parties relating to the Program and supersedes all prior or contemporaneous understandings, promises, negotiations, representations or agreements, whether oral or written, relating to the subject matter.

19.               Amendment. This Agreement may be modified or amended only by a written instrument signed by both Parties with the same formality as this Agreement. However, upon the enactment of any law, regulation, court decision or relevant government publication and/or interpretive guidance or policy that City believes in good faith will adversely impact City's ability to operate the Program, City may unilaterally amend this Agreement to comply with such law, regulation, court decision or government publication, guidance or policy by delivering a written amendment to Primary Member, and that amendment shall be effective thirty (30) days after receipt.

20.               Governing Law. This Agreement shall be governed by and construed and interpreted in accordance with the substantive and procedural laws of the State of Nevada, without giving effect to its choice or conflicts of law provisions.

21.               Venue. All actions shall be initiated in the courts of Clark County, Nevada or the federal district court with jurisdiction over Clark County, Nevada. Primary Member agrees that s/he shall not on behalf of herself/himself or an Additional Member, and no Additional Members shall, initiate an action against City in any other jurisdiction concerning this Agreement. Primary Member irrevocably agrees to submit, and to cause each Additional Member to submit, to the exclusive jurisdiction of the courts located in Clark County, Nevada over any dispute or matter arising under or in connection with this Agreement.

22.               Headings; Cross References. The section and subsection headings contained in this Agreement are used solely for convenience and do not constitute a part of this Agreement, nor should they be used to aid in any manner in the construction of this Agreement. All references in this Agreement to Sections and Subsections are to Sections and Subsections in this Agreement, unless otherwise specified. When not inconsistent with the context, words used in the present tense include the future tense, words in the plural include the singular, and words in the singular include the plural and the masculine gender includes the feminine gender. Unless otherwise expressly stated, words not defined herein shall be given their common and ordinary meaning

23.               Interpretation. Each Party acknowledges that the Party carefully reviewed this Agreement, that each had the opportunity to consult an attorney, and that each fully understands its provisions, and, accordingly, the normal rules of construction to the effect that any ambiguities are to be resolved against the drafting party are not to be employed or used in any interpretation of this Agreement.

24.               Electronic Means. The Parties agree to Primary Member submitting his/her application by electronic means and to the Parties signing this Agreement with electronic signatures.