REMSA HEALTH SILVER SAVER MEMBERSHIP TERMS & CONDITIONS

• This is not an application for an insurance policy. If you are already a current Silver Saver plan member, you do not need to fill out this entire application.
• I understand that my Silver Saver Membership fee covers my portion of ground transportation that are applied to co-insurance or deductibles by my insurance or Medicare for medically necessary transports.  “Medically Necessary” is defined as a specific need of air ambulance or ground ambulance transport to the nearest medically appropriate hospital as requested by a physician or as directed by state / county protocols.
• I understand that Silver Saver memberships are not an insurance policy nor are they meant to be a substitute for health coverage. If my insurance company or other health benefits payor denies payment to REMSA Health because it determined that my air or ground ambulance services were not medically necessary, I will be responsible for the payment of the fees for those services less a 30% discount because I am a Silver Saver member.
• I understand that the Silver Saver membership covers those persons permanently residing in my household and listed on my application. A “household” is defined as all persons who permanently reside at the Head of Household’s physical address listed on the membership application or in a nursing home.
• I understand that Silver Saver benefits only apply when REMSA Health transports a member.
• I understand that my membership only covers Silver Saver. I understand I have the ability to select both the Care Flight air medical transport membership and the Silver Saver for REMSA Health ground transport membership or just a single membership if desired.
• I understand that the Silver Saver membership program may be cancelled at any time for any reason.
• I understand that my membership is non-transferable and non-refundable and not tax deductible.
• I understand that Medicaid/Medi-Cal recipients are not eligible for Silver Saver membership due to their health care policies. By completing this application, I attest that those persons listed in the application are not a Medicaid or Medi-Cal recipient.
• I understand that REMSA Health will bill and receive payment from my health care insurance company. I also understand that if I receive payments for services from my health care insurer, I am responsible to immediately forward that payment onto REMSA Health.
• I understand that REMSA Health will treat failure to forward Medicare or insurance payments onto REMSA Health as insurance fraud and legal action may be taken. I also understand that my failure to forward insurance or Medicare Payments will result in termination of my membership with REMSA Health and I am responsible for full charges for services rendered.
• I understand that the effective date for my membership is the date that REMSA Health receives my completed application and membership fee plus a three day waiting period. Memberships are effective for one year.