EMS Passport is a subscription program designed to help eliminate out-of-pocket patient expenses, such as health insurance co-payments and deductibles, when emergency ambulance transportation is required. EMS Passport offers protection against rising health care costs. Since the implementation of the county’s Revenue Recovery program in July 2002, individuals requiring emergency ambulance transportation have been charged for this service. Upon enrollment, subscribers will not be responsible for any additional balances or fees, except as required by law or regulation, after insurance claims are processed. Some individuals (such as Medicaid-only beneficiaries) may not be eligible for EMS Passport, and others may not need to subscribe to the program. Potential subscribers should check with their health insurance carrier to determine if the EMS Passport program is right for them.
Who is eligible
All county residents, those who work in the county, and college or university students are eligible to subscribe. The enrollment costs are $29 for individual coverage and $59 for families of two or more people. Family subscriptions also include family members who reside in nursing or assisted-living facilities located in Chesterfield County, who otherwise would be at the listed household address, as well as any person in the household who does not have insurance coverage. All individuals must be listed on the application to ensure coverage. The EMS Passport subscription is effective after Chesterfield County Fire and Emergency Medical Services receives both payment and signed subscription form. Subscriptions are valid Oct. 1, 2012 through Sept. 30, 2013, and are nonrefundable, nontransferable and not tax deductible. Late subscriptions will be accepted, however, subscriber fees are not prorated.
Subscription Program Terms
An enrollment form must be completed and submitted for processing, with your check or money order, to Chesterfield County Fire and Emergency Medical Services. If you are not a current member, you will not be able to subscribe at the time services are rendered.
The EMS Passport program is not a contract for the provision of ambulance services. This is not a solicitation for the offer or sale of an insurance product. The terms and provisions of this EMS Passport program are subject to change without prior notice. Medicare beneficiaries may be billed for co-payments or deductibles if required by law. All subscriptions are subject to acceptance by the county and may be canceled or revoked in the county’s sole discretion. The subscriber acknowledges that the county will bill available medical and third-party insurance (auto or homeowners) for services rendered and agrees to remit any third-party insurance payments received directly by the subscriber to the county.
How to Enroll in the Subscription Program
Download the EMS Passport Registration Form - EMSPassportApplication.pdf (Adobe PDF files can be printed exactly as intended by anyone with free Adobe® Acrobat® Reader software. )
Complete the fill-in form online, print the completed application, and mail with your payment to:
Chesterfield Fire and EMS
P.O. Box 1658
Chesterfield, VA 23832
EMS Passport Subscription-Family
EMS Passport Subscription-Individual
If you have any questions, or need assistance completing this application, please call 804-768-7524.
As with any medical emergency, please dial 911 for immediate service. Chesterfield County Fire and EMS will promptly respond to your medical emergency regardless of membership status with the EMS Passport program.