HomeMy WebLinkAboutAGMT - MEDEX Assistance Corporation (MEDEX Services) •
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MEDEX ASSISTANCE CORPORATION SERVICE AGREEMENT
On this _I `_ _ day of ,2� `�`�", MEDEX Assistance Corporation, Inc., located at
8 0 L Salle_ R ad, Suite 200, To MD 21286 reinafter, "ME EX" agrees to provide to
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(herei a er, "Employes") certain MEDEX services described below and (subject to the terms and
conditions stated herein (the "Services "). The Services shall be available to Employer's eligible ,
employees who are covered under the terms and conditions of a group insurance policy issued by
the Standard Insurance Company (hereinafter "Participants "), in consideration of a premium paid
by Employer.,
THE SERVICES
The Services described below are available to Participants who are traveling one hundred (100) miles or
more from their permanent residence or who are traveling in a country that is not their country of
permanent residence. All Services must be arranged by MEDEX. No claims for reimbursement will be
accepted. Except where it is indicated below that MEDEX shall pay for the Service, any and all
expenses associated with the Services, including, but not limited to the cost of medical care and
treatment, are the responsibility of the Employer and /or the Participant.
MEDICAL ASSISTANCE SERVICES
Emergency Evacuation: If Participant suffers an Injury or Sickness and adequate medical facilities are
not available locally in the opinion of MEDEX's Medical Director, MEDEX will provide emergency
evacuation (under medical supervision if necessary) by whatever means necessary to the nearest facility
capable of providing adequate care. Services include arranging and paying for transportation and
related medical services (including cost of medical escort) and medical supplies necessarily incurred in
connection with the emergency evacuation.
Medically Necessary Repatriation: After initial treatment and stabilization for an Injury or Sickness of
Participant, if the attending Physician and MEDEX's Medical Director deem it medically necessary,
MEDEX will transport the Participant back to his or her permanent place of residence for further medical
treatment or to recover. Services include arranging and paying for transportation and related medical
services (including escort if necessary) and medical supplies necessarily incurred in connection with the
repatriation.
Repatriation of Remains: In the event of the death of a Participant, MEDEX will render assistance and .
provide for the return of mortal remains. Services include: location of a sending funeral home;
transportation of the body from the site of death to the sending funeral home; preparation of the remains
for either burial or cremation; transportation of the remains from the funeral home to the airport;
minimally necessary casket or air tray for transport; coordination of consular services (in the case of
death overseas); and procuring death certificates; transport of the remains from the airport to the
receiving funeral home. Other Services that might be performed in conjunction with those listed above
include making travel arrangements for any traveling companions and identification and /or notification of
next -of -kin.
Family or Friend Transportation Arrangements: If a Participant is hospitalized for more than seven
(7) days and is traveling alone, MEDEX will arrange and pay round trip economy airfare transportation
costs for one (1) family member or friend of the Participant to visit the hospitalized Participant.
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Return of Dependent Children: If a Participant is hospitalized for more than seven (7) days, MEDEX
will pay for one -way economy airfares to return the Participant's dependent children who are under
eighteen (18) years of age and accompanying him /her on the trip, to their permanent residence, and
MEDEX shall arrange and pay for an escort, if necessary.
GENERAL ASSISTANCE SERVICES
Locating Medical Care: MEDEX will assist Participants in locating medical care providers or local
sources of medical care referral.
Case Communications: MEDEX is available to monitor the status of a Participant's medical case and
to communicate between the patient and his /her Employer, or family, physicians, school, travel
company, consulate, etc., as needed.
Hotel Convalescence Arrangements: MEDEX can assist Participants with hotel arrangements if the
Participant or their companion needs to convalesce in a hotel prior to or following medical treatment.
Medical Insurance Assistance: MEDEX can assist Participants by coordinating notifications to medical
insurers or managed care organizations, verifying policy enrollment, confirming medical benefits
coverage, guaranteeing medical payments, assisting in the coordination of multiple insurance benefits,
and handling claims paperwork flow.
Prescription Drug Assistance: When permitted by law and approved by the patient's physicians,
MEDEX will assist Participants in obtaining prescription drugs and other necessary personal medical
items that may have been forgotten, lost or depleted while traveling.
Vehicle Return: If the Participant has been Evacuated or Repatriated and a non - commercial vehicle is
left unattended, MEDEX will return such Stranded Vehicle.
Pet Care and Return: If Participant is unable to travel and requires hospitalization due to Injury,
Sickness, or death, MEDEX will arrange for any pets traveling with the Participant to be cared for at a
local kennel. If the medical condition of the Participant requires transportation to another hospital or
health care facility, or to the Participant's permanent residence, MEDEX will provide assistance with pet
return requirements and, if necessary, make arrangements for the . pet(s) to be returned to a family
member or friend as chosen by the Participant. The Participant will be responsible for all costs of
transportation, housing and care of pet(s).
LEGAL ASSISTANCE
Locating Legal Services: MEDEX can assist Participants to contact a local attorney or the appropriate
consular officer when a Participant is arrested or detained, is in an automobile accident, or otherwise
requires legal representation or advice. MEDEX will maintain communications with the Participant, family
and Employer until legal counsel has been retained by the Participant.
Bail Bond Services: MEDEX can coordinate bail bond services for a Participant in all available
locations.
BAGGAGE ASSISTANCE
MEDEX can assist Participants whose baggage is lost, stolen, or delayed while traveling on a common
carrier. MEDEX will advise Participants of the proper reporting procedures and will assist Participants to
maintain contact with the appropriate companies or authorities to resolve the problem.
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EMERGENCY PAYMENT ASSISTANCE
MEDEX can assist the Participant in obtaining an advance of funds for medical expenses or other travel
emergencies by coordinating funds transfer with the Participant's credit card company, bank, family, or
other sources of credit.
PRE -TRIP ASSISTANCE - available at any time; not subject to 100-mile requirement
Passport and Visa Information: MEDEX can advise Participants of the required documentation to
enter and depart foreign destinations.
Health Hazards Advisory: MEDEX can provide Participants with up to date travel advisories.
Inoculation Requirements: Medical entry requirements can be provided to Participants prior to their
departure.
Weather Information: MEDEX maintains current information regarding weather conditions for both
domestic and international travel destinations. This information will be provided to Participants through
the MEDEX Assistance Center.
Currency Exchange Information: MEDEX can provide Participants with the daily currency exchange
rate for a specified country.
Consulate and Embassy Locations: MEDEX maintains a complete listing of consulates and
embassies. The locations can be provided to Participants by calling the MEDEX Assistance Center.
Translation and Interpreter Services: Professional translators and interpreters can be reached 24
hours a day to obtain translation or interpretation assistance during emergency situations while traveling
internationally.
Travel Locator. Service: Participants can contact the MEDEX Assistance Center 24 hours a day for
assistance in locating hotels and airports.
EMERGENCY MESSAGE ASSISTANCE
MEDEX can relay emergency messages to family members. The Participant or his /her family members
may retrieve these messages at any time.
EMERGENCY CASH ASSISTANCE
MEDEX can assist Participants with emergency cash. Arrangements will be made through a friend,
family member, or the Participant's credit card in the event of an emergency.
EMERGENCY TICKET REPLACEMENT
MEDEX can assist Participants in replacing lost or stolen airline tickets.
EMERGENCY CREDIT CARD REPLACEMENT
MEDEX can assist Participants with emergency credit card replacement if the Participant should
experience a loss, theft, or damage to their credit card.
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TERMS AND CONDITIONS
The Services are subject to the following terms and conditions:
MEDEX will provide services as long as the applicable fees have been paid to MEDEX.
MEDEX will not pay Emergency Evacuation, Medically Necessary Repatriation, or Repatriation of
Remains expenses incurred for any one of the following reasons: suicide or attempted suicide;
intentionally self - inflicted injuries; participation in any war, invasion, acts of foreign enemies, hostilities
between nations (whether declared or not), or civil war; participation in any military maneuver or training
exercise; piloting or learning to pilot or acting as a member of the crew of any aircraft; mental or
emotional disorders, unless hospitalized; being under the influence of drugs or intoxicants, unless
prescribed by a Physician; commission or the attempt to commit a criminal act; pregnancy and childbirth
(except for complications of pregnancy); traveling against the advice of a physician; traveling to obtain
medical services or treatment; traveling to obtain medical services when care can be delivered at the
Employer's health and /or medical facilities; or expenses incurred for emergency evacuation or
repatriation as a result of Injury or Sickness while traveling within one hundred (100) miles of
Participant's place of permanent residence; or expenses incurred for emergency evacuation or
repatriation as a result of Injury or Sickness while on a trip in excess of ninety (90) consecutive days.
When the services provided by MEDEX are covered in whole or in part by an insurance policy or other
health insurance plans, MEDEX shall be subrogated to the rights and causes of action of the person for
whom services are rendered against said insurance policy or other insurance plans, except for plans or
policies sponsored by the Employer.
All transportation benefits provided hereunder must be by the most direct and economical route
possible.
For the purposes of this Agreement, the following definitions shall apply: "Injury" means identifiable
injury caused by an Accident. "Accident ", means a sudden, unexpected, unusual, specific event, which
occurs at an identifiable time and place. "Sickness" means 'a sickness of the Participant that declares
itself during the period when Services are available under this Agreement.
MEDEX reserves the right to suspend, curtail or limit its Services in any area in the event of rebellion,
riot, military uprising, war, labor disturbances and strikes, nuclear accidents, acts of God, or refusal of
the authorities in a country to permit MEDEX to fully provide Services. MEDEX will, however, endeavor
to provide Services to the best of its ability during any such occurrence. It is the responsibility of the
Participant to inquire whether a country is "open" for assistance Services.
MEDEX is not responsible and cannot be held liable for damages caused by any provider of Services
unless they are employees of MEDEX. Providers are generally independent contractors who are not
controlled by MEDEX. Doctors and lawyers are providers who are independent and not controlled by
MEDEX. Any malpractice performed by a local physician or attorney is not the responsibility of MEDEX.
MEDEX is not responsible for loss or damage to the Participant's vehicle during the return of the vehicle,
or loss or damage to any personal belongings.
Legal actions arising hereunder shall be barred unless written notice thereof is received by MEDEX
within one (1) year from the date of the event giving rise to any such cause of action.
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A waiver of liability may be required if any evacuation is not deemed by MEDEX's Medical Director to be
in the best interest of the Participant. A copy of the waiver is available for review.
Printed Material: Employer shall submit to MEDEX for pre - approval all printed materials that (a)
Employer proposes to disseminate to a Participant or any other person or entity; (b) describing MEDEX
Assistance Services or listing phone, fax, e-mail or other numbers /addresses to be used to contact
MEDEX.
Employer Contact Person: Employer shall designate an Employer contact person or persons
(hereinafter, "Contact Person "). For each Contact Person, Employer shall provide name, title and the
following contact numbers, if "available: primary residence phone, second or vacation home phone;
mobile phone; business phone; all fax numbers; and all e-mail addresses. The Contact Person shall be
available 24 hours a day to verify a Participant's eligibility for Services under this Agreement. Employer
and MEDEX shall cooperate to create eligibility verification procedures that will assure that the eligibility
of Participants can be determined by MEDEX in a timely manner.
Employer Contact Person(s): ,,
1) Name: CAMG-(Y'f ( Business Phone: Z. 431 Z 17
2) Name: Business Phone:
Employer After Hour Contact(s):
1) Name: __.6 YI!k1 Lee_ After Hour Phone: :111421.0 _ ggZ°I__
2) Name: After Hour Phone: _
A MEDEX representative shall contact each Contact Person to (a) obtain all of the contact information
described above; (b) to familiarize the Contact Person with the Services; and (c) to agree upon eligibility
verification procedures.
MEDEX shall be obligated, under the terms of the Assistance Service Agreement to seek from
Policyholders participating in the Program a means satisfactory to MEDEX to verify coverage of an
eligible Participant prior to rendering of service by MEDEX.
In the event MEDEX is unable, for any reason, to obtain said verification, MEDEX agrees to provide
services whenever there is reasonable cause to believe that the individual in need of services is an
eligible Participant. In such situations, MEDEX will verify coverage with the policyholder as soon as
possible, whether during or after the performance of service by MEDEX. In no event shall the
Policyholder (except to the extent the Policyholder agrees to guarantee payment of services provided to
Participant) or Standard be liable to MEDEX for the cost of services rendered to or for a person, whether
or not such person is an eligible Participant.
Indemnification: To the fullest extent permitted by law:
(a) MEDEX shall defend, indemnify and hold harmless Employer and all agents, employees,
officers, directors, successors and assigns thereof from and against any and all losses,
claims, demands, suits, judgments, costs, damages (including compensatory or punitive
damages), expenses (including attorney's fees and costs of litigation), and any other liabilities
of any nature, founded or unfounded, arising out of or from, resulting from, connected with, or
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in any way relating to (i) any act or omission of MEDEX that results in a claim against
Employer or MEDEX's failure to duly perform and observe any duty, term, provision,
covenant, agreement or condition of this Agreement.
(b) Employer shall defend, indemnify and hold harmless MEDEX and all agents, employees,
officers, directors, successors and assigns thereof from and against any and all losses,
claims, demands, suits, judgments, costs, damages (including compensatory or punitive
damages), expenses (including attorney's fees and costs of litigation), and any other liabilities
of any nature, founded or unfounded, arising out of or from, resulting from, connected with, or
in any way relating to (i) any act or omission of Employer that results in a claim or suit against
MEDEX or Employer's failure to duly perform and observe any duty, term, provision,
covenant, agreement or condition of this Agreement.
(c) The indemnification obligations set forth above shall not be construed to negate, abridge, or
otherwise reduce any other right or obligations of indemnity, which would otherwise exist as
to a party or person described in this section.
(d) The above indemnification obligations shall survive termination of this Agreement.
Term of Agreement: This Agreement shall remain in effect until the earlier of: (a) the date terminated by
the Employer or MEDEX by advanced written notice to the other party at least ninety (90) days prior to
the termination date, or (b) the date of the termination or cancellation of the Employer's group insurance
policy with Standard Insurance Company. In the event of any termination, MEDEX shall complete any
assistance cases that arose prior to the date of termination or the event giving rise to termination.
FOR MEDEX ASSISTANCE CORPORATION:
SIGNATURE: TITLE: President & CEO
NAME: Bruce Kirby TELEPHONE: 410 - 453 -6300
DATE:
FOR EMPLOYE - /
SIGNATURE: _ TITLE: Clf_lvk8C{
• I : 5 - I - 2527
NAME (print)�r: V�_�I�D��, I TELEPHONE: �2
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DATE: _______<1/2/0 - - --
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