membership

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Why become a h.a.l.a.s. member?

A membership with Hollidaysburg American Legion Ambulance Service covers emergency transports and medically necessary transports to the nearest facility providing appropriate services. The membership program also covers the provision of non-emergency ambulance services for local service area transports!

All family members residing in the same household are covered under one membership. This includes UNLIMITED emergency transports for the year of membership.

Hollidaysburg American Legion Ambulance Service Membership Form

Annual Rate: $75.00 (Covers all members of your household) Jan.1 thru Dec. 31st.

First Name

Last Name

Address

City

State

Zip Code

Subscriber Information

Subscriber First Name

Subscriber Last Name

Subscriber Birth Date

Household Members

Member 1 First Name

Member 1 Last Name

Member 1 Birth Date

Member 2 First Name

Member 2 Last Name

Member 2 Birth Date

Member 3 First Name

Member 3 Last Name

Member 3 Birth Date

Member 4 First Name

Member 4 Last Name

Member 4 Birth Date

Member 5 First Name

Member 5 Last Name

Member 5 Birth Date

Terms of Membership

1) Hollidaysburg American Legion Ambulance Service Members are entitled to unlimited emergency medical services that meet medical necessity guidelines. Medical necessity is established when the patient could not be transported by any other means than ambulance without endangering their health. If the patient could be transported by a wheelchair van, car, taxi, etc., then medical necessity does not apply. Patient/family preference transports are not covered by this subscription.

2) The base rate for transports to hospitals outside the local area are also covered by the terms of the membership.

3) When membership status (i.e. individuals to rest home) address or any additions or deletions to the membership change, the member must notify the business office.

4) In the event ambulance services rendered are not covered by the subscriber's insurance due to failure to comply with applicable coverage requirements or no applicable insurance exists, HALAS shall provide a 50% discount off its usual and customary charge for such services. In addition, the members' subscription will cover 50% of copayments and the deductibles billed to the third party insurer.

5) Services not covered- Round trip transports for treatment and/or special services at other facilities while you are a patient in the hospital and/or transportation to a facility when the same services was available at a closer facility.

6) Mileage charges outside of the service area are not covered by the membership and may be billed to the member if not covered by insurance.

7) This membership authorizes the Hollidaysburg American Legion Ambulance Service to bill and receive any available funds due from Medicare or other insurance carriers for services rendered. Failure to comply with the terms of the membership may void all future benefits of your membership.

I accept terms & conditions

*Payments are collected via paypal. You do not need a paypal account to finalize this transaction. You may pay with your credit/debit card by clicking on the 'Pay with Debit or Credit Card' button during the payment process.

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