Attachment 7 - Medical Statement - 18 August 2022 - 1 page.pdf

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Attached to
Cleaning Control Towers' Windows
Solicitation number
FA448426Q0020
Issued by

About this file

This document is a mandatory statement for inclusion in federal solicitations, awards, task orders, delivery orders, and calls with performance requirements on Joint Base McDill Dix Lakehurst (JBMDL).

The statement establishes the terms and conditions for emergency medical care provided by the 87th Medical Treatment Facility (MTF) to contractor employees and agents who sustain work-related injuries while on duty at JBMDL. The 87th MTF may provide urgent health care, defined as medical care necessary to save life or limb and prevent undue pain and suffering, with contractor employees transferred to civilian medical facilities once appropriately stabilized. All costs for such treatment are the financial responsibility of the contractor or contractor employee and will not be borne by the 87th MTF, the United States Air Force, or the government. Billing is processed based on services documented on Air Force Form 552 (Pre-Hospital Evaluation Patient Care Report). If payment cannot be made when the bill is rendered, the government will issue a statement of charges and letter of indebtedness to the contractor employee. Contractors must ensure their employees provide timely notice to their medical insurance carriers and furnish adequate information and documentation to enable insurance payment.

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Text version

The following statement will be placed in all solicitations/awards/TOs/DOs/calls with performance on JBMDL:

“The 87th Medical Treatment Facility (MTF) may provide urgent health care to any contractor employees or agents for injuries occurring while on duty. Urgent health care is defined as medical care authorized to the extent necessary to save life or limb and prevent undue pain and suffering. Contractor employees will be transferred to a civilian medical facility as soon as they are appropriately stabilized. The cost of such treatment will be paid for, in full, within a reasonable period of time (as determined with/by the Base Legal Office's assistance), by the contractor or the contractor's employee and will not be borne by the 87th MTF, the United States Air Force or the government. Billing/accounts receivable is processed based on services provided, which is captured on an Air Force FORM 552 (Pre-Hospital Evaluation Patient Care Report). If a contractor employee or agent cannot pay for the treatment at the time the bill is rendered, a statement of charges and a letter of indebtedness will be completed and billed to such contractor employee for medical services rendered. Contractor employee or agents shall ensure they provide timely notice to their medical insurance company and to the extent an insurance company is to make payment, provide the insurance company with adequate information and documentation necessary to make payment."

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