§ 6-101. Medical service program and fee; terms and conditions of the program.

(a)

Each single-family residential utility customer and multi-family residential utility customer within the corporate limits of the City shall be included in the medical service program, unless the utility customer affirmatively declines participation in said program in the manner set forth in Section 6-102 of this article.

(b)

Single-family residential utility customers participating in the program shall have included within their utility bills a charge of $3.65 per month.

(c)

Multifamily residential utility customers participating in the program shall be billed $3.65 per month per occupied living unit. There is a rebuttable presumption that 50 percent of the total number of living units served solely by a single Oklahoma City utility bill are occupied. The number of presumed living units shall be rounded down, but to not less than one.

(d)

The total number of living units attributed to multifamily residential utility customers and landlords shall be based upon the number of housekeeping units on record with the Oklahoma City Utilities Department. It is the responsibility of all multifamily residential utility customers and landlords to annually confirm with the Utilities Department whether this number of housekeeping units is in fact accurate. Adjustments may be made to the number of housekeeping units on record with the Utilities Department based on information provided by sworn affidavit from the multifamily residential utility customer or landlord and confirmed by the City. Multifamily residential utility customers and landlords shall make staff available to meet at the subject residences with City Utilities Department personnel to confirm the number of living units as provided for by the utility customer in the sworn affidavit mentioned herein.

(e)

Any customer whose account is in disconnection of service for nonpayment status per Section 55-79, following the Utilities Department current administrative policies and procedures, shall be automatically removed from the program and said customer and the customer's household shall not receive the benefits of the Medical Service Program. The utility bill shall be deemed to have been notice to the customer and the customer's household of any delinquency or failure to pay the Medical Service Program. Should any customer be removed from the Medical Service Program for failure to pay or late payment, then neither said customer nor any member of said customer's household shall be permitted to re-enroll at the customer's address until the utility bill of such address is no longer considered delinquent as defined in Section 55-78 of this Code.

(f)

Program benefits. Any customer who participates in the Medical Service Program, shall receive the benefits of membership in EMSA's EMSAcare Program and is subject to all rules applicable to said program. EMSAcare membership covers the participating customer and all permanent members of that customer's household. A "permanent household member" shall mean all individuals permanently residing at a specific residence, regardless of age or whether there is a blood relation, and includes a utility customer's spouse being cared for in a nursing home facility. A person visiting the residence for a temporary period of time is not considered a permanent household member. EMSAcare membership benefits are applied to emergency and non-emergency ambulance transports provided by EMSA within the EMSA service area. Emergency transports are fully covered. An emergency is defined as an unforeseen condition that requires urgent and unscheduled medical attention. Emergency transports always result in the ambulance taking the patient to a hospital emergency room.

(g)

Non-emergency transports are fully covered if insurance or other third-party coverage provides benefits for the service (even if subject to deductible, co-payment or co-insurance). If no insurance or other third-party coverage is available or if the claim is denied, the EMSAcare member is charged a reduced fee (40 percent off EMSA's standard non-emergency rate). A non-emergency transport is a medical transfer that does not have a hospital emergency room as the final destination.

(h)

Excluded services. EMSAcare members must present a completed physician certification statement (PCS) to receive benefits for non-emergency transports. EMSAcare provides no coverage for non-emergency transports without a PCS. The patient's physician usually completes certificates. Repetitive transports for services such as dialysis, radiation therapy and chemotherapy are not eligible for EMSAcare benefits without additional screening and insurance approvals. EMSAcare does not cover non-emergency transports to and from doctors' offices, dentists' offices, physical therapy centers, pharmacies, freestanding clinics and other facilities. Transports outside of EMSA's service area are also not included in the program. Members will receive a full bill for excluded services.

(i)

Customer's obligations under the program. A participating utility customer shall provide to EMSA within 60 days of the date of receiving EMSA services, any valid insurance and third-party payer information pertaining to the customer or anyone living in his/her household who receives EMSA services. Failure to provide EMSA with said information, nullifies the benefits under this Program. Said customer must furnish any information requested by his/her insurance company in order to facilitate payment of ambulance claims for the customer or any permanent residents of customer's household. In consideration for payment of the monthly membership fee, the customer assigns to EMSA all ambulance benefits that any covered family member or the customer may otherwise be entitled to receive from any insurance or other third-party payer for services provided under the EMSAcare program membership. EMSA will accept this assignment as payment in full for emergency transports, and for non-emergency transports if insurance or other third-party payer coverage provides benefits for the transport. EMSA will file ambulance insurance claims for each covered person and is entitled to receive payment from all insurance or other third-party payers up to the amount of EMSA's usual charges. Any insurance or other third-party payment the customer receives, related to EMSA's services provided under the EMSAcare membership, shall immediately be delivered to EMSA, if there is an outstanding balance on the customer's account. Violation of these terms will result in termination of the customer's participation in the EMSAcare program and the customer will be billed for all charges related to services provided.

(Ord. No. 23765, § 2, 12-16-08; Ord. No. 24494, § 1, 7-17-12; Ord. No. 24978, § 1, 9-23-14 )