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.