Premium Tiers
Three Tiers of Insurance Premiums
Each tier combines a tier-specific premium with a standard premium. A Sempouse surcharge applies when the Sempouse MTEC risk-reduction module is not installed.
CDS
Clinical Driver Specialist
Non-emergency medical-necessity transport. Ambulatory, wheelchair, walker-assisted, oxygen-dependent, and high-risk discharge trips.
Premium Breakdown
Tier Premium$1,200
Standard Premium$1,200
Sempouse Surcharge (without)+$600
With Sempouse
$2,400
Without Sempouse
$3,000
Coverage Structure
CDS Auto Liability
Professional Liability
Sempouse Risk Reduction
No General Liability
Payer: Hospital / CMS discharge benefit
CDS+911 Yellow
Non-Critical Emergency
Non-critical emergency transport. Scene-ready stabilization, behavioral health, and urgent medicine delivery within the Caravan 911 Buddies protocol.
Premium Breakdown
Tier Premium$2,400
Standard Premium$1,200
Sempouse Surcharge (without)+$600
With Sempouse
$3,600
Without Sempouse
$4,200
Coverage Structure
CDS Auto Liability
Professional Liability
Sempouse Risk Reduction
Caravan 911 Eligible
No General Liability
Payer: Hospital / CMS discharge + transfer benefit
CDS+911 Red
Critical Emergency
Critical-emergency transport operated by Paramedics license. High-priority scene response, advanced stabilization, and full Caravan 911 Buddies dispatch with mix-gender compliance.
Premium Breakdown
Tier Premium$3,600
Standard Premium$1,200
Sempouse Surcharge (without)+$600
With Sempouse
$4,800
Without Sempouse
$5,400
Coverage Structure
CDS Auto Liability
Professional Liability
Sempouse Risk Reduction
Full Caravan 911 Dispatch
No General Liability
Payer: Hospital / CMS critical-emergency benefit
ACCORD-137 Architecture
A Liability-Separation Doctrine
ACCORD-137 is the first model that separates transport liability from clinical liability. Traditional insurers cannot map it because they think in "Business → GL + Auto + Professional + Umbrella." This system thinks in "Healthcare → CMS + EMTALA + ADA + CDS + Taya Foundation."
01
Hospital
Discharge liability — EMTALA stabilization before release
02
CMS
Access-to-care liability — medical-necessity inbound transport
03
CDS Driver
Transport-zone liability only — no clinical liability
04
Taya Foundation
Governance liability — risk-pooling, compliance, oversight
Traditional Insurers Understand
General Liability
Commercial Auto
Professional Liability
Umbrella Policies
Workers' Comp
Premises Liability
Product Liability
They cannot see the ACCORD-137 structure — not because it isn't profitable, but because they literally cannot map it.
ACCORD-137 Requires
EMTALA discharge law
CMS medical-necessity rules
ADA transport compliance
Hospital RCM billing logic
Medical-necessity access pathways
Liability separation (hospital vs vendor)
Non-profit risk-pooling models
Inbound vs discharge liability boundaries
Premium = risk-pooling + fairness + compliance — not profit.
iSMART2 Trip-Type Specification
Three Federally Distinct Trip Types
iSMART2 must classify every transport request into one of three categories — each carries a different CMS payer rule, liability boundary, insurance structure, RCM billing pathway, and CDS operational responsibility.
01Discharge Trip
Hospital → Home
TripType = DISCHARGE
Definition
A trip initiated by the hospital as part of the EMTALA/CMS discharge pathway.
Liability Boundary
Hospital retains full discharge liability. LMT-Express carries transport-zone liability only. No General Liability required.
Payer
Hospital / CMS discharge benefit
Insurance Coverage
CDS Auto Liability
Professional Liability
Sempouse
No inbound premium
iSMART2 System Rules
› TripType = DISCHARGE
› No percentage premium added
› RCM routed under discharge-transport code
› CDS driver receives transport fee only
02Inbound Trip
Home → Hospital
TripType = INBOUND
Definition
A trip initiated by the patient or MCS to access medically necessary care.
Liability Boundary
CMS owns access-to-care liability. CDS owns transport-zone liability. Taya Foundation owns governance only. No General Liability required.
Payer
CMS inbound medical-necessity benefit (never patient, driver, or Foundation)
Insurance Coverage
CDS Auto Liability
Professional Liability
Sempouse
Inbound premium = 10% of transport fee
iSMART2 System Rules
› TripType = INBOUND
› Add 10% inbound premium
› Transport fee → CDS driver
› Inbound premium → Taya Foundation risk pool
› Entire invoice → hospital RCM → CMS
03Transfer Trip
Hospital → Healthcare Facility
TripType = TRANSFER
Definition
A trip initiated by the hospital to move a patient between healthcare facilities.
Liability Boundary
Hospital retains transfer liability. LMT-Express carries transport-zone liability. No General Liability required.
Payer
Hospital / CMS transfer benefit
Insurance Coverage
CDS Auto Liability
Professional Liability
Sempouse
No inbound premium
iSMART2 System Rules
› TripType = TRANSFER
› No percentage premium added
› RCM routed under inter-facility transport code
› Medical report attachment required
Liability Architecture
Liability Summary Table
Invoice Structure (Per Trip)
TripType
Origin & Destination
Transport Fee
Inbound Premium (if applicable)
CDS Driver Payment Allocation
Taya Foundation Risk-Pool Allocation
CMS Billing Code
Hospital RCM Routing Tag
CMS Billing Logic
Payer Rules by Trip Type
DISCHARGE
CMS pays discharge-transport benefit
No inbound premium
INBOUND
CMS pays transport fee + inbound premium
Premium routed to Taya Foundation risk pool
TRANSFER
CMS pays inter-facility transport benefit
No inbound premium
System Enforcement Requirements
What iSMART2 Must Enforce
Enforcement Controls
Trip-type selection
Premium calculation
Liability routing
RCM billing code assignment
CMS payer mapping
CDS driver payment allocation
Taya Foundation risk-pool allocation
Medical-report attachment for transfers
This Ensures
CMS compliance
EMTALA alignment
ADA transport safety
Liability separation
Institutional clarity
Audit-ready documentation