Membership Plan and Fees
Membership Plan
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Single Individual Membership- $50 Annually
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Senior (+65) Individual - $50 Annually
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Senior Family- $50 Annually
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Family Plan- $60 Annually
Description of Plan Benefits
Health insurance coverage can fall short and may not cover all ambulance charges. The Escalon Community Ambulance Membership plan offers you and your family a convenient and low cost means of covering ambulance costs which are not covered by your insurance when using ECA. Under the Plan, ECA agrees to accept what the member’s insurance pays as payment in full for a medically necessary ambulance transport. The member agrees to assign and transfer to ECA all proceeds of all insurance or other payments of any kind payable for ambulance transports covered by the Plan.
The Plan is not an insurance policy, nor is it meant to be a substitute for health insurance. If you have no insurance or other coverage's, or if your insurer denies payment you will be responsible for payment of all charges for those services. However, ECA members will be given a discount rate that is equivalent to 120% of Medicare allowable.
PERSONS COVERED: Membership covers you and under the FAMILY program, covers your spouse, and any “dependent” children or family that live with you and receive their mail at your address. An acceptable form of identification may be required to verify their address.
EMERGENCY TRANSPORTATION: We provide “Emergency Ambulance” service on a twenty four hour basis. To obtain emergency transportation, dial 911. In emergency situations, we will respond as soon as possible with the nearest available ambulance unit. ECA will transport the individual needing care from any accessible location in the ECA service area to local hospitals in San Joaquin or Stanislaus counties, as appropriate for the patients care.
NON-EMERGENCY TRANSPORTATION: Non-emergency transportation service is provided only when medically necessary. A physician must authorize your transportation.
PLAN EXCLUSIONS Benefit Limitations:
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Any service or injury covered by workers compensation insurance
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Any injury arising from and caused by a state of war or a state of emergency
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Air ambulances services or any other type of service other than ground ambulance services provided by Escalon Community Ambulance
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Any service requiring special staffing or equipment
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Event coverage
This plan does not pay members for transportation provided by another ambulance service. Members will be liable for the full charge for any services rendered which are not covered under this plan. If the plan is canceled anytime within the plan year, ECA will reimburse members their annual fee on a pro rata basis.
TERMINATION OF BENEFITS: This plan expires in one year if members do not renew unless you have selected auto-renew for members paying with a credit card. ECA will rescind the contract of any member who uses fraud or deception to obtain plan services.
If ECA accepts as applicant’s fee after the expiration date and after the time for notice has expired, ECA will reinstate the applicant’s contract as though it had never expired, unless ECA either:
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Refund the applicant’s payment; or
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Issue the applicant a new contract, with a written notice explaining the ways in which the new contract is different from the old one.
REIMBURSEMENT PROVISION:
ECA retains the right to accept or reject any individual’s application, except as provided by law. Once an application has been accepted, ECA may not cancel a plan membership because of health reasons.
SPECIAL NOTICES:
(A) BEFORE YOU PURCHASE: If you are currently enrolled in a health maintenance organization (HMO) or other health insurance, the benefits provided by an Ambulance Plan may duplicate the benefits provided by your HMO or other health insurance. If you have a question regarding whether your HMO or other health insurance offers benefits for ambulance services, you should contact that other company directly.
(B) WARNING: This Ambulance Plan is not an insurance program. It will not compensate or reimburse another ambulance company that provides emergency transportation to you or your family. This may occur when the 911 Emergency System has independently determined that another company could provide more expeditious service or is next in the rotation to receive a call. This might also occur when this Ambulance Plan is unable to perform within a medically appropriate timeframe due to a mechanical or maintenance problem or being on another call.
(C) COMPLAINTS: For complaints regarding this Ambulance Plan, first attempt to call the Plan at 209-838-1351. If the Ambulance Plan fails to resolve the complaint to your satisfaction, contact the Department of Managed Health Care at 1-800-400-0815. The Department's website is http://www.dmhc.ca.gov. You may obtain complaint forms and instructions online.
(D) OPERATING UNDER CONDITIONAL EXEMPTION: This Ambulance Plan is operating pursuant to an exemption from the Knox-Keene Health Care Service Plan Act of 1975 (Health and Safety Code section 1340 et seq.)
