Terms and Conditions
TERMS
1. Subscription Period
The subscription period is one year. Enrollment starts the date your completed application and subscription payment is received by Mono County Emergency Medical Services (“MONO COUNTY EMS”).
2. Subscription Renewal
This Agreement is automatically renewed for additional subscription periods upon the payment of the Subscription fee in effect at the time of the renewal without executing a new agreement. However, MONO COUNTY EMS reserves the right to require subscribers to execute a new agreement upon expiration of a subscription period.
3. Subscription Fee
The annual fee for a subscription period, or any portion thereof, is sixty-five dollars ($65) for a single or multiple person household. This fee is payable in advance and is a NON-REFUNDABLE FEE. The fee is forfeited in the event the Subscriber moves out of MONO COUNTY EMS’s service area or terminates this Agreement. No refunds shall be issued in the event the Subscriber abuses the Program and membership is terminated pursuant to the terms of this Agreement.
4. Subscription Benefits
A Subscriber who has fully executed and satisfied the terms of this Agreement and the Program, paid the subscription fee and meets eligibility requirements is entitled to no more than three (3) medically necessary basic life support services, advanced life support services or transportation for the subscription period for the Subscriber and for each of his or her eligible dependents. Payment in full for any ambulance transport by a private insurance company, etc., will not count toward this three-transport maximum. In the event that the Program fails to cover eligible ambulance services under the terms of this Agreement, the Subscriber or eligible dependent shall not be liable to Mono County for any sums owed by the Program for such ambulance services.
5. Potential Benefits of Mono County EMS Subscription – Outside Mono County
Other participating reciprocal agencies may extend subscriber benefits to areas outside MONO COUNTY EMS’s service area [Mono County]. These benefits are limited to the terms of agreement in effect for the participating agency providing services at the time benefits are used. Subscribers who receive ambulance services from a participating agency may be eligible for benefits offered by that agency to its subscribers. The subscriber agrees to abide by the participating agency’s terms of agreement. A current list of participating agencies is on file in the MCEMS business office and website. Mono County, its employees, officers, agents, volunteers and assigns are not responsible for the type, level, or quality of services provided by a participating agency nor is MONO COUNTY EMS financially responsible for any costs or charges for services provided by any other ambulance service provider. MONO COUNTY EMS is not responsible for the withdrawal of participating agencies. Participating agencies are subject to change without notice.
6. Subscriber Eligibility
Only people residing within the service area of MONO COUNTY EMS are eligible to enroll in the Program. Mono County residency may be subject to verification based on review of Subscriber’s utility bills.
The following people are ineligible:
A. Anyone with outstanding and unpaid bills for past MONO COUNTY EMS services rendered.
B. Anyone whose subscription was terminated due to abuse of the Subscription Program.
C. Corporations, partnerships, associations, cooperatives and all other organizations of people.
7. Dependent Eligibility
A MONO COUNTY EMS Subscription includes all permanent residents of the same single-family occupancy, non-commercial residence within Mono County who live together as dependents of that family unit and are listed as such on income tax returns (including domestic partners but excluding mere roomers or boarders). Such individuals are considered members of the same household for purposes of the Program. Individuals not included in this definition must obtain a separate subscription. For Subscribers living in a multi-unit or apartment building, the physical place of residence is limited to the unit, apartment or area occupied by the Subscriber.
To be eligible, a Subscriber’s dependents, as defined above, must be enrolled with the MONO COUNTY EMS at the time MONO COUNTY EMS ambulance services are provided. It is the sole duty of the Subscriber to inform MONO COUNTY EMS, in writing of any additions or deletions of persons listed as eligible dependents. Only those persons who meet all subscriber eligibility requirements, including the required assignment of insurance or medical benefits AND are listed in the subscriber record at the time EMS services are rendered are eligible for benefits.
Subscribers must promptly notify MONO COUNTY EMS of any change in residence or any other change in facts pertaining to the eligibility of any individual included in a MONO COUNTY EMS Subscription.
8. Limitations on Benefits
A. Medically Necessary Services. Enrollment in the Program does not entitle the Subscriber to receive MONO COUNTY EMS ambulance services or ambulance transportation services that are not medically necessary. “Medically necessary” is defined as a specific need for ambulance services or transportation where use of other services or forms of transportation, such as a private car or taxi, would be medically inappropriate. The absence of alternative services or methods of transportation does not, by itself, constitute medical necessity. If a Subscriber and/or eligible dependent requests MONO COUNTY EMS ambulance services and MONO COUNTY EMS determines that the services requested are not medically necessary, Subscriber/eligible dependent will be liable for the full actual charges for such services. If Subscriber or eligible dependent refuses transport. Subscriber/eligible dependents may be responsible for the full actual charges billed. MONO COUNTY EMS reserves the right to require physician certification of medical necessity.
B. Origination and Destination of Trips and Services. Only transportation initiated from within MONO COUNTY EMS’s service area is covered by the Program. This includes medically necessary and approved transfers from healthcare facilities within the MONO COUNTY EMS service area to other facilities within 100 miles. Transportation to any location within MONO COUNTY EMS’s service area is covered as well as to any medical facility in Inyo County, Douglas County, Carson City or Reno with physician approval. In all transportation, the destination shall be governed by existing medical protocols. Subscriber/dependent will be responsible for all costs of transportation to locations not covered by the Program.
C. Air Ambulance Services and Other Ambulance Services Are Not Included. The Subscriber/dependent is responsible for all costs for air flight ambulance services. No air ambulance services are provided by MONO COUNTY EMS and such services re only available through other ambulance operators. MONO COUNTY EMS does not exercise control over these services, and they are not included in the Program.
D. Maximum Transports. A maximum of three ambulance transports during each calendar year shall be covered under the terms of this Agreement for each individual subscriber and each eligible dependent participating in the Program. Payment in full of any ambulance transport by a private insurance company, etc., will not count toward this three-transport maximum.
E. Assignment Prohibited. Subscriber may not assign any rights or duties under this Agreement without formal approval executed in writing by MONO COUNTY EMS.
9. No Change in MONO COUNTY EMS Duties
Nothing in this Agreement shall be construed as imposing an additional duty on behalf of MONO COUNTY EMS to provide individual or special ambulance services to the Subscriber. The Subscriber understands and acknowledges that MONO COUNTY EMS provides ambulance services to the public and that this Agreement does not create a special duty or change or alter the priority MONO COUNTY EMS establishes for a response to a request for service.
10. Medical Insurance
Subscriber acknowledges and agrees that MONO COUNTY EMS has made no representations as to whether a Subscriber should or should not carry any type of insurance. This Agreement does not require Subscriber to carry medical insurance which covers ambulance service. In the event a Subscriber does carry medical insurance, Subscriber agrees to provide MONO COUNTY EMS all the insurance information requested at the time of enrollment. Subscriber agrees that MONO COUNTY EMS may seek reimbursement for the actual cost of the services it renders. To facilitate claims processing, Subscriber authorizes such payments to be made directly to MONO COUNTY EMS.
If Subscriber receives payment from any insurer or medical benefit provider for services provided by MONO COUNTY EMS, Subscriber shall promptly forward that payment to MONO COUNTY EMS. If Subscriber fails to remit any such payment to MONO COUNTY EMS, Subscriber's membership shall be terminated, and Subscriber will be billed for the full costs of services provided.
No reimbursement beyond the limits of the Subscriber’s insurance, if any, shall be sought. If the Subscriber’s or eligible dependent’s insurance carrier denies a claim as medically unnecessary, MONO COUNTY EMS will exhaust all appeals to accomplish payment. If the appeals fail, the Subscriber/dependent shall be responsible for all costs incurred for the ambulance service provided for that claim.
Persons who receive Medicaid or Medi-Cal medical benefits need not subscribe in order to have full coverage for services under Medicaid or Medi-Cal. Therefore, persons who receive Medicaid/Medi-Cal need not apply for a MONO COUNTY EMS Subscription. However, such persons may subscribe to the Program to provide coverage for their eligible dependent household members who do not have the same overage.
11. Assignment of Insurance Benefits (for subscribers with insurance)
Subscriber assigns and authorizes payment of insurance or other benefits for ambulance services directly to MONO COUNTY EMS, according to the terms of this Agreement and as itemized on claim forms. The subscription fee covers any applicable deductible, co-insurance, or co-payment and Subscriber expects and understands that the usual and customary insurance reimbursement for ambulance services will be paid directly to MONO COUNTY EMS.
12. Liability under this Agreement
Nothing in this Agreement shall be construed as changing or altering the liability of Mono County, its employees, officers, agents, volunteers and assigns for negligent acts or omissions. As to matters covered by this Agreement, Subscriber hereby agrees to indemnify and hold harmless Mono County, its employees, officers, agents, volunteers and assigns against any and all liability, claims, demands, costs, losses and expenses, including attorney fees, for damage to property or injury including death to persons arising, or asserted to have arisen from the active or passive negligence or actual or alleged breach or default of this Agreement by Mono County, its agents, representatives, volunteers or employees whether sole or contributory.
13. General Matters
A. This Agreement contains the entire agreement between the parties, and any statement, promise or inducement made by either party or agent of either party not contained in this written Agreement shall not be valid or binding, except for rules or conditions of the Program established by MONO COUNTY EMS.
B. This Agreement may not be enlarged, modified or altered except in writing by MONO COUNTY EMS.
C. The headings appearing in this Agreement have been inserted for convenience and ready reference and they do not purport to, and shall not be deemed to define, limit or extend the scope or intent of the clauses to which they appertain.
D. All notices required by this Agreement shall be in writing, must be sent to the addresses provided herein and are deemed effective upon placement in the United States Mail, postage prepaid.
E. This Agreement shall be enforced and construed according to the laws of the State of California.
F. A copy of this Agreement may be used in place of the original Agreement.
G. The address of the Subscriber is as listed above. The address and phone number for MONO COUNTY EMS is as follows:
Mono County Emergency Medical Services
Ambulance Subscription Division
P.O. Box 511
Bridgeport, CA 93517
(760) 932-5485
14. Cancellation
MONO COUNTY EMS reserves the right to cancel and refund a prorated portion of the Subscriber’s enrollment fee based upon the unexpired enrollment period if the Mono County Board of Supervisors determines that the operation of this Agreement is no longer in the best interest of Mono County. MONO COUNTY EMS will notify all Subscribers through regular mail at least thirty (30) days prior to canceling this Agreement.
15. Grievances
Grievances should be directed to Mono County Emergency Medical Services, Ambulance Subscription Division, P.O. Box 511, Bridgeport, CA 93517, phone (760) 932-5485. A form for registering a written grievance is available from MONO COUNTY EMS offices, 199 Twin Lakes Road, Bridgeport, CA 93517,and on its Website at https://www.monocounty.ca.gov/ems.
