LifeLift Ambulance Membership Program Agreement
This LifeLift Ambulance Membership 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
membership program, referred to as the HFD LifeLift
Ambulance Membership Program, (the "Program") is
a voluntary membership 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 membership will be deemed to have expired and the membership
fee forfeited. The Primary Member and any Additional Members are referred to as "Covered Members."
3. One-Year Membership; Effective Date of Membership;
Agreement Termination. This Agreement is effective on the
date City signs this Agreement. Primary Member's membership in the Program is valid from the effective date of membership
and expires automatically on the last day of the same month
of the following year. For example, if the effective date is January
19, 2020, the membership will expire on January 31, 2021 at 11:59:59 pm Pacific
time. The membership 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 membership
through the on-line portal; (b) Primary Member signs this Agreement; (c) that application is processed;
and (d) full payment of the membership fee is received by City.
City will provide electronic confirmation of the effective date of Primary Member's membership.
This Agreement shall terminate on the date Primary
Member's membership 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 Membership. City reserves
the right to stop operating the Program, cancel the Primary
Member's membership and refund a prorated
portion of the Primary Member's membership fee based upon
the unexpired membership 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 membership and identify the date the
cancellation is effective.
5. Membership Fees and Plans. Program membership fees are non-transferrable and, except as provided in Section
4, non-refundable. There are three membership plans, and Primary
Member has selected the TBD Plan:
(A) Individual Plan. The annual membership fee is $59, and
Primary Member is the only person included in the membership.
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 membership 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 membership.
(C) Family Plus Plan. The annual membership 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 membership.
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 membership period, Primary Member's membership plan will remain the same and City will not refund any portion of
the membership fee. If Primary Member wishes to add one or more Additional
Members during the membership
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 membership period wishes to add one
or more Additional Members, Primary Member must request that his/her membership be converted to the Family Plan or Family Plus Plan, as applicable, and pay the additional amount due
for the membership 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 membership 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 membership 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 membership period wishes to add one
or more Additional Members that would cause the
membership to include more than five Additional Members,
Primary Member must request that his/her membership
be converted to the Family Plus Plan and pay the additional amount due for the membership
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 membership
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 membership is effective, and no Program benefits are available for a Covered Member after the membership 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 membership 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.
(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 membership 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 membership 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 membership 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) and 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 membership 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.
City:
CITY OF HENDERSON, NEVADA
By: Shawn White
Fire Chief
Primary Member:
By:
TBD
Agreed and Submitted from IP Address: 3.232.129.123:56828 on 2/25/2021