For Memberships at Oriental Mindoro Emergency Medical Service Inc.
Primary Care is an ambulance subscription program sponsored by Oriental Mindoro Emergency Medical Service Inc. (ORMEMS). Primary Care provides for the prepayment of the co-payments and deductibles for all medically necessary ambulance services, emergencies, for which the patient has financial responsibility. Primary Care also provides a reduced fee for non-emergency transports that are not covered by insurance. Primary Care is not an insurance policy or supplement. Membership is good through 1 year.
Whos is Covered:
One Primary Care individual membership covers an individual for PHP 2,000.00 per year. If there are more family members (a spouse and any children under the age of 21, up to 6 persons together), their membership will cost PHP 8,000.00 per year while the seventh person and up is covered for an an additional amount of PHP 1,700.00 per year per person.
The “Health Mo Care Ko” (HMCK) membership covers an individual for PHP 100.00 per month. The duration of HMCK membership is also 1 year and is automatically extended if it is not canceled 2 months before the expiration. If the member fails to make the due payment in one month, the suspended status occurs after 14 days of delay in payment and ORMEMS is exempt from any service under the membership conditions for an additional 2 months, whereby the obligation to pay the ongoing subscription fees does not expire.
Excluded Services:
Primary Care provides no coverage for non-emergency transports. Individual transports to the doctor’s office, dentist’s office, therapy centers, pharmacies etc. are NOT covered by Primary Care but eligible to our reduced member prices.
Membership Benefits:
Primary Care membership benefits are applied to emergency quick response and emergency transport in ORMEMS service area.
Emergency transports are fully covered. An emergency is defined as an acute unforeseen medical condition that poses an immediate risk to a person’s life or long-term health and requires urgent and nonscheduled medical attention and being endorsed to and accepted by an Emergency Room.
Non-emergency transports are fully covered if an insurance provides benefits for the transport. If an insurance or any other 3rd party payor denies benefits for a non-emergency transport, the Primary Care member will receive a 25 % discount off the standard non-emergency fee. A physician will have to sign the medical necessity certificate for non-emergency transport to be considered for benefits. ORMEMS reserves the right to settle billing with the patient for the time being.
Agreement
I acknowledge that my insurance provider or I are responsible for payment of ambulance service provided to me by ORMEMS. In consideration and payment of the membership fee, I hereby assign to ORMEMS all benefits that I (or any covered family / HMCK member) may otherwise be entitled to receive from any insurance or other third-party payor for service provided under my Primary Care membership. ORMEMS will accept this assignment as payment in full for emergency ground transort if insurance or other third-party payor coverage provides benefits for the transport. I understand ORMEMS will file my ambulance insurance claims for each covered person and is entitled to receive payment for all insurance or other third-party payor up to the amount of ORMEMS usual charges. For non-emergency services a Physician’s Certification Statement must be signe by the patient’s physician. If the physician states the ambulance was not medically necessary and the patient or family wants ambulance transport, Primary Care Members will be billed 75 % of the standard non-emergency charge. Any insurance or other third-party payment I receive related to ORMEMS’ services I will immediately deliver to ORMEMS. I also understand that ORMEMS’ Primary Care membership is only good in the area of service.
Severability clause
Should any part of this agreement be invalid, the rest of the agreement remains unaffected.
The place of jurisdiction is Calapan.
Puerto Galera, March 15, 2020