|SaveAir Membership Program|
At American Medflight, we understand that lifesaving aeromedical transportation may cause an unexpected financial burden. Even insured patients may be left with thousands of dollars in out-of-pocket expenses. To provide peace of mind, we offer an affordable option through our SaveAir membership program. Once you become a member, we will work with your insurance company to secure payment for our aeromedical care and transportation, and waive any remaining balance due.
SaveAir Membership Application
SaveAir Membership Agreement
By signing the Membership Agreement, I agree, on behalf of myself and the residents of my household listed on the Application Form, to the following terms and conditions:
Term of Coverage: Coverage will begin 14 days after receipt of completed application and payment by American Medflight and will expire 364 days from that day.
Persons Covered: Membership covers me and the household members (collectively, "Members") listed on the Application Form, so long as they remain full-time residents of the specified household. New household members may be added, household members may be deleted or the household location changed by written notice to American Medflight, effective the day following receipt by American Medflight of such notice. References to "I" or "me" and similar references shall be construed as including all Members.
SaveAir Membership Program Coverage: I understand that my SaveAir membership fee covers my portion of American Medflight's charges that are applied to co-insurance by Medicare or other insurance for medically necessary transports that are not covered by secondary insurance. I understand that I am responsible for meeting any and all deductibles required by my insurance provider. "Medically necessary" is defined as specific need for air ambulance transportation to the nearest appropriate medical facility as determined by a physician or insurance carrier.
Eligibility: I understand that SaveAir Membership Program coverage will be granted only to those who are insured by Medicare, or a major medical insurance provider that covers at least 70% of American Medflight's regular charges. Membership may be granted, at the sole discretion of American Medfllight, to those who have insurance with a "cap" for air ambulance transportion. Members with "capped" insurance coverage will be responsible for the difference, if any, between the "capped" amount and 70% of American Medflight's regular charges.
Exclusions: I agree that if I have no insurance or other health coverage, or if my insurance company or other health benefits payer denies payment to American Medflight because it determines that my air ambulance services were not payable, I will be responsible for the payment of fees for those services, less a 30% discount because I am a SaveAir member. Membership is not offered to Medicaid/Medi-Cal recipients and I verify that I am not a Medicaid/Medi-Cal recipient.
Elective Transportation: I understand that as a Member of the SaveAir Membership Program, I will receive a 30% discount for elective, non-medically necessary air ambulance transportation provided by American Medflight. Elective transportation requires scheduling and payment arrangements at least 24 hours in advance.
Assignment of Insurance Benefits: I hereby assign to American Medflight, Inc., all rights and benefits that I have under any and all medical, health, supplemental, worker's compensation, liability, auto or homeowner's insurance policies or plans, or from other third party payers or sources which provide coverage or would otherwise pay for air ambulance services covered by this membership. If I have Medicare, I request that payment or authorized Medicare benefits be made on my behalf to American Medflight, Inc., for any air ambulance service provided by American Medflight. If I receive payment from Medicare or my insurance company, I will immediately forward that payment to American Medflight, Inc. If I do not, I understand that my membership may be terminated and I will be billed full charges for American Medflight services. I acknowledge that I am responsible for payment of air ambulance services.
Additional Provisions: I understand and agree as follows: My SaveAir membership does not include ground transportation. The SaveAir membership is non-transferable and non-refundable. The SaveAir Membership Program may be cancelled at any time for any reason. American Medflight transports patients based on medical need, not membership status, and normally transports patients to the nearest appropriate medical facility. My SaveAir membership will not apply if I am transported by an air ambulance company other than American Medflight. American Medflight may be unable to respond to a request for service within a medically appropriate period due to all aircraft being on other calls, weather, maintenance, or other circumstances beyond its control.
(Revision date 11/01/2011)