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EMS Passport is a subscription program to help citizens
defray out-of-pocket expenses, such as health insurance co-payments and
deductibles, when they need emergency ambulance transportation. Individuals
may be billed for emergency ambulance transportation under the county’s
Revenue
Recovery Program. Your subscription fees are applied to all available
co-payments and deductibles. The subscription program is not a solicitation
for insurance coverage. However, subscribers are not responsible for
any additional balances or fees except as required by law or regulation.
Some individuals, such as Medicaid beneficiaries, may not be eligible
for EMS Passport, and others may not need to subscribe
to the program. Check with your insurance provider to find out if EMS
Passport is right for you.
 You
are eligible
For $59 a year, a subscriber may enroll all members of his or her household.
Citizens who work in, but do not reside in, Chesterfield County and students
attending colleges and universities within the county are eligible to
subscribe.
Please note our service area is limited to Chesterfield County in most cases and that some volunteer rescue squads in the county do not charge for emergency ambulance transportation. An EMS Passport subscription is effective after the Chesterfield County Fire and Emergency Medical Services office receives both your payment and signed subscription form. Subscriptions are valid Oct.1 through Sept. 30 of the current subscription year and are non-refundable and non-transferable.
Subscription Program Terms
The annual cost for an EMS Passport subscription
defrays out-of-pocket expenses for the uninsured portion of any charges
for emergency ambulance transportation that ends at a hospital.
An EMS Passport subscription includes individuals
who reside at the listed address. It also includes family members who
reside in assisted-living or nursing facilities located within Chesterfield
County who otherwise would be at the listed address and are on the application.
An enrollment form must be completed and submitted for processing,
with your check or money order, to the Chesterfield County Treasurer’s
Office. 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. Medicaid beneficiaries are not eligible
to subscribe. 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 third-party insurance 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
If you have any questions, or need assistance completing this application,
please call (804) 768-7524.
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Chesterfield
Fire & EMS