Attachment 8 - Medical Statement_ 18 August 2022.pdf
PDF 82 KB Posted
- Attached to
- Wastewater & Grease Removal Services JBMDL
- Solicitation number
- FA448426R0015
About this file
FA4484-26-R-0004 – Integrated Solid Waste Management Services: Medical Statement (Attachment 3)
This is a medical liability and payment responsibility clause for contractor employees and agents working on federal contract FA4484-26-R-0004 for Integrated Solid Waste Management Services. The 87th Medical Treatment Facility (MTF) may provide urgent health care to contractor personnel for on-duty injuries, defined as medical care necessary to save life or limb and prevent undue suffering. Contractor employees will be transferred to civilian medical facilities once appropriately stabilized. The contractor or contractor's employee—not the 87th MTF, United States Air Force, or government—bears full financial responsibility for all emergency medical treatment costs, which must be paid within a reasonable timeframe as determined by the Base Legal Office.
Billing is processed based on services documented on Air Force FORM 552 (Pre-Hospital Evaluation Patient Care Report). If immediate payment is not possible, the 87th MTF will issue a statement of charges and letter of indebtedness to the contractor employee. Contractor employees and agents are required to notify their medical insurance companies promptly of any treatment received and provide insurers with all necessary documentation and information to facilitate payment processing.
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FA4484-26-R-0004 – Integrated Solid Waste Management Services
Attachment 3 – Medical Statement
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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