Authority Advantage Membership Agreement Terms

Acknowledgement
I (the primary applicant and any other person(s) listed on the application, if applicable) understand that Authority Advantage is not insurance and does not reduce the obligations of any third party payer.  I understand that I must use the service of Marshall Area Fighters and Ambulance Authority to be eligible for membership benefits, and that emergency calls have first priority.  The service area includes the City of Marshall, Burlington, Convis, Clarendon, Eckford, Fredonia, Lee, Marshall, Marengo, and Tekonsha Townships.   I understand that Authority Advantage membership limits my out-of-pocket cost related to ambulance transports covered by insurance for medically necessary ground ambulance transport.  I also understand that I am obligated to pay for ground ambulance services not defined as medically necessary. I also understand that many area fire departments assist with medical emergencies and that Authority Advantage does not pay for those services.

Eligibility
Enrollment is only offered to those residing in the service areas listed above and who are covered by insurance.  Medically necessary ambulance trips that are not covered by insurance are rendered at a 20% discount from regular rates.

Medically Necessary
Medically necessary ground ambulance service is defined as the specific need for emergency care or stretcher ambulance transportation to and from a hospital where other forms of transportation would be medically inappropriate given a patient’s condition.

Membership Coverage
Those covered by this membership include the primary applicant and other residents living at the address listed on the completed application.  Membership is only available to residences within the Authority area listed above.

Membership Services
For the membership fee and assignment of rights, the Authority Advantage program agrees to provide emergency ambulance service for me and /or listed members from any location in the membership service area.  It is also agrees to provide medically necessary non-emergency ground ambulance services to and from hospitals according to the terms of this membership.  I understand that transportation to a physician’s office, dentist, physical therapy center, or pharmacy is not covered. 

Consent to Third Party Reimbursement
As a member, I agree and consent to allow the ambulance service to file for and collect payment for ambulance services provided to me under any health insurance policies, plans, or benefit programs, up to the total amount charged for ambulance services.

Reimbursement for Membership Services
I understand that, as a member, I will make available all medical insurance and benefit information to the program.  I understand that I am ultimately responsible for payment of any service provided which is not medically necessary. 

Agreement to Remit Payments for Services Provided
I agree to forward immediately to the ambulance service all payments for services rendered sent directly to me from any insurance company or medical benefits plan.  I understand that failure to comply with these terms will result in membership termination and forfeiture of benefits associated with membership, and that I shall be obligated to pay all balances in full.

Non-emergency Ambulance Transportation
I understand that non-emergency ambulance transportation to and from hospitals (i.e. transports other than those for sudden and unexpected injury or illness) will be covered by the membership only if medically necessary.  Non-emergency transportation to Doctor offices, Dentist offices, Physical therapy centers, and Pharmacies are not covered. 

Cancellation of Membership
I understand that the Authority Advantage program has the right to terminate memberships and/or refund membership fees at its sole discretion.

 Download the Authority Advantage Membership Agreement*

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