LIFEGUARD EMERGENCY GROUND AMBULANCE MEMBERSHIP AGREEMENT
SERVICE AREA: HOUSTON COUNTY, TX
MEMBERSHIP BENEFITS: Lifeguard, dba Houston County Emergency Medical Services, is the exclusive ground ambulance provider in Houston County, TX. Lifeguard membership benefits apply only to medically necessary, emergency ground ambulance transports conducted by Lifeguard within Houston County (Covered Transports). For Covered Transports, Lifeguard will waive any amounts (e.g., co-pays, deductibles and balance billing) owed by the Member to Lifeguard after applying any amounts received from applicable insurance, other benefits and responsible third parties. Normal billing will apply to non-Covered Transports.
- Medically necessary, emergency transports involve the transport of a patient with a sudden, unforeseen medical condition with symptoms of sufficient severity such that the absence of immediate medical attention could result in placing the health of the patient in serious jeopardy. Emergency transports always result in taking the patient to the closest appropriate hospital emergency department. Member benefits do NOT apply to non-emergency transports, such as: repetitive transports for services such as dialysis, radiation therapy and chemotherapy, and transports to or from doctors’ offices, dentists’ offices, physical therapy centers, pharmacies, freestanding clinics or other facilities.
- Lifeguard is NOT responsible for payment for services provided by another ambulance service. Membership is not an insurance policy and cannot be considered as a secondary insurance coverage or a supplement to any insurance coverage.
Membership begins the day after Lifeguard receives the Member’s complete Application and full payment.
HOUSEHOLD COVERAGE: Membership covers the designated primary Member and all persons listed in the Application who dwell in a shared living space with the primary Member. Household members may be added or deleted, and the household location may be changed, by written notice to Lifeguard that is effective the day after receipt by Lifeguard.
MEMBERSHIP APPLICATION AND FEE: The Member represents to Lifeguard that all information in the Application is accurate and complete, and that the Member is not a Medicaid beneficiary. Lifeguard reserves the right to request documentation demonstrating the accuracy of such information. Members who are Medicare beneficiaries and who have supplemental insurance may not need a Membership. The Member agrees to pay Lifeguard the applicable non-refundable and non-transferable membership fee specified in the Application.
INSURANCE ASSIGNMENT: The Member is financially liable for the cost of Covered Services, except to the extent waived under this agreement. Within 30 days after Covered Services are rendered, the Member will provide to Lifeguard any applicable insurance and third-party responsibility information, or will advise Lifeguard that no such coverage exists. In addition, the Member will provide to any applicable insurance company or responsible third party any information necessary to facilitate payment of claims for Covered Services.
Lifeguard reserves the right to bill directly any appropriate insurance, benefits provider or third party for Covered Services rendered, and the Member authorizes all insurers, benefits providers and responsible third parties to pay any covered amounts directly to the Lifeguard. The Member understands and acknowledges that Lifeguard will file insurance claims for Covered Services and will be entitled to receive payment from all insurance and third party responsibility claims up to the amount of Lifeguard’s usual charges. The Member authorizes any insurance or benefits provider, or other responsible third party, to pay any amounts for Covered Services directly to Lifeguard. The Member assigns to Lifeguard all benefits from any insurance or third-party responsibility claim relating to Covered Services. The Member agrees to remit immediately to Lifeguard any insurance or other third-party payment received for Covered Services.
CHOICE OF LAW. Any and all matters arising out of or relating to the membership program, these terms and conditions, and/or the subject matter hereof shall be governed by, construed, and enforced in accordance with the laws of the United States of America (including without limitation, the Federal Arbitration Act) and, to the extent not preempted by Federal law, the laws of the State of Alabama without regard to conflicts or choice of law principles, regardless of the legal theory upon which such matter is asserted. To the extent a state or political subdivision thereof makes the incorporation of common law duties or state law in contracts optional, Lifeguard and you agree that this contract does not incorporate any such common law duties or state laws.
ARBITRATION AGREEMENT. Any controversy or claim arising out of or relating to the membership program, these terms and conditions, and/or the subject matter hereof shall be resolved by binding arbitration by a single arbitrator pursuant to the Consumer Arbitration Rules of the American Arbitration Association (“Rules”), as modified by these terms and conditions. The place of arbitration will be Birmingham, Alabama. The judgment on any award rendered by the arbitrator may be entered in any court having jurisdiction thereof. THERE SHALL BE NO RIGHT OR AUTHORITY FOR ANY CLAIMS TO BE ARBITRATED ON A CLASS ACTION, JOINT OR CONSOLIDATED BASIS OR ON BASES INVOLVING CLAIMS BROUGHT IN A PURPORTED REPRESENTATIVE CAPACITY ON BEHALF OF OTHER MEMBERS OR OTHER PERSONS. THE ARBITRATOR MAY AWARD RELIEF ONLY IN FAVOR OF THE INDIVIDUAL PARTY SEEKING RELIEF AND ONLY TO THE EXTENT NECESSARY TO PROVIDE RELIEF WARRANTED BY THAT INDIVIDUAL PARTY’S CLAIM. The arbitrator is not authorized to award attorney’s fees and costs or equitable relief. In the event the prohibition on class arbitration or any other provision in this arbitration agreement is deemed invalid or unenforceable, then the remaining provisions of these terms and conditions will remain in full force and effect. In the event of any dispute between the parties, you agree to first contact the Lifeguard and make a good faith effort to resolve the dispute before resorting to arbitration under these terms and conditions.
AGREEMENT: Members must be natural persons. These terms and conditions supersede all previous terms and conditions between a Member and Lifeguard, including any other writings or verbal representations relating to the terms and conditions of Membership. The Member accepts and agrees to these terms by manually or electronically signing the Application, by verbally accepting and agreeing to these terms and/or by remitting payment of the membership fee to Lifeguard. If the Member violates or breaches any of these terms, then this Membership agreement will be immediately terminated and normal billing terms will apply.