AMBULANCE MEMBERSHIP PROGRAM AGREEMENTAmbulance Membership Program Agreement • July 28th, 2021
This agreement provides membership in the ambulance subscription program known as the AFMA Ambulance Membership Program. The annual membership fee per household alleviates the member’s liability for cost-sharing amounts for medically necessary ground ambulance service within the approved AFMA service area, to the nearest appropriate medical facility, for the subscriber and household members for one year, including physician-authorized, medically necessary ambulance service from a point within the AFMA approved area to a hospital within the State of Arizona. The annual fee for this program is $83.74 per household.
Ambulance Membership Program AgreementAmbulance Membership Program Agreement • June 24th, 2019
This agreement provides membership in the ambulance subscription service known as the AFMA Ambulance Membership Program. The annual membership fee per household (‘household’ defined as legal spouse or domestic partner including children under the age of 26, living at the address) provides emergency ground ambulance service and medically necessary non-emer-gency ground ambulance service authorized by a physician within the approved AFMA service area, to the nearest appropriate medical facility, for the subscriber and household members for one year, effective on the first day of the month following receipt of payment. Membership also provides physician-authorized, medically necessary ambulance service from a point within the AFMA approved area to any other hospital within the State of Arizona. The annual fee for this service is currently be $75.00 per household.
Ambulance Membership Program AgreementAmbulance Membership Program Agreement • February 20th, 2024
This Ambulance Membership Program Agreement ("Agreement") is entered into by the member identified below, and the member's spouse/dependent(s) listed on the Enrollment Form (collectively, the 'Member"), and the Adams County Fire Protection District ("District").
Ambulance Membership Program AgreementAmbulance Membership Program Agreement • July 9th, 2019
This agreement provides membership in the ambulance subscription service known as the AFMA Ambulance Membership Program. The annual membership fee per household (‘household’ defined as legal spouse or domestic partner including children under the age of 26, living at the address) provides emergency ground ambulance service and medically necessary non-emergency ground ambulance service authorized by a physician within the approved AFMA service area, to the nearest appropriate medical facility, for the subscriber and household members for one year, effective the date your completed subscription agreement and fee are received and approved by the Authority. Membership also provides physician-authorized, medically necessary ambulance service from a point within the AFMA approved area to any other hospital within the State of Arizona. The annual fee for this service is currently $75.00 per household.
Terms of AgreementAmbulance Membership Program Agreement • February 12th, 2020
Definitions: The Arvada Fire Protection District Ambulance Membership Program ("Program") is a voluntary ambulance membership program operated by the Arvada Fire Protection District ("District"). The program is not insurance. It is in addition to any medical benefits a Program member may have. The District will bill a program member's insurance or other coverage for ambulance services, and the District is entitled to all amounts paid by a Program member's insurance or other coverage for the District's ambulance services, up to the total dollar amount charged by the district for the services provided.
Ambulance Membership Program AgreementAmbulance Membership Program Agreement • October 31st, 2024
This Ambulance Membership Program Agreement ("Agreement") is entered into by the member identified below, and the member's spouse/dependent(s) listed on the Enrollment Form (collectively, the 'Member"), and the Adams County Fire Protection District ("District").
