Delaware Township Volunteer Ambulance Corp.


Subscription Program



Subscription donations are used to purchase emergency equipment, medical supplies, medications and to provide training to our volunteers.
Although we are a volunteer organization, we must bill for our services. An ambulance transport can cost more than $1,000. Most insurance providers, including Medicare do not cover the entire portion of the ambulance bill. You can help both yourself and our organization by participating in our subscription drive.

About the Subscription
As a subscription member, you will not be billed for balances owed on service s that are partly covered by your insurance carrier including insurance copays and deductibles, with the exception of deductibles as mandated by Federal Law. On non-covered services such as non-emergency transports, and patient assessments (patient is not transported) you will receive a 50% discounted rate. Subscription plans are valid from September 15, 2017 through September 30, 2018. There is no “proration” for those who wait to subscribe, so the sooner you sign up, the greater the benefit.


Cost:
$30 Individual - covers only the individual subscription holder
$50 Couple - cover the subscription holder & spouse listed on this form.
$75 Household - covers the subscription holder, spouse, co-inhabits of a single residence and dependent persons living at the residence (up to 8 persons).

Payment Liabilities Not Covered Under the Subscription:
Insurance pays for ambulance transportation in accordance with the terms of your policy. In certain situations, a subscriber may be financially responsible for payment for ambulance service that is non-covered by your insurance and you may not be advised of this non-coverage at the time of your service. This subscription does not cover services provided by advanced life support providers. In cases where the transport is not medically necessary or not provided, you are uninsured, or where you were able to take another form of transportation, as a subscription member you will be financially responsible for 50% of the charges normally imposed by Delaware Township Volunteer Ambulance Corps.

Important Insurance Information:
Usually, DTVAC will try to directly bill your insurance company using a third-party billing service. In consideration and payment of the subscription fee: I hereby assign to DTVAC all ambulance benefits that I (or any covered family member) may otherwise be entitled to receive from any insurance or other third-party payer for services provided under my DTVAC subscription, now or in the future. Failure to comply would be fraudulent under our subscription agreement and consequently void your subscription benefits. This program is not an insurance product and this is not an offer for the sale of an insurance policy. Subscription membership is not applicable to Medical Assistance (Medicaid) recipients.

Non-Discrimination
Delaware Township Volunteer Ambulance Corp. does not discriminate on the basis of race, color, national origin, sexuality, age, sex, disability, or gender identification. 





Complete the form and mail your payment to: Delaware Township Ambulance 135 Park Road Dingmans Ferry, PA 18328.


If you have any questions about our subscription program, please call us at (570) 828-234 or email info@dtvac.org.