·  This is not an application for an insurance policy. If you are already a current Flight Plan plan member, you do not need to fill out thisentire application.

·  I understand that my Flight Plan Membership fee covers my portion of Care Flight services that are applied to co-insurance or deductibles by my insurance or Medicare for medically necessary transports.  “Medically Necessary” is defined as a specific need of air ambulance or ground ambulance transport to the nearest medically appropriate hospital as requested by a physician or as directed by state / county protocols.

·  I understand that Flight Plan memberships are not an insurance policy nor are they meant to be a substitute for health coverage.  If my insurance company or other health benefits payor denies payment to Care Flight because it determined that my air or ground ambulance services were not medically necessary, I will be responsible for the payment of the fees for those services less a 30% discount because I am a Flight Plan member.

·  I understand that the Flight Plan membership covers those persons permanently residing in my household and listed on my application.  A “household” is defined as all persons who permanently reside at the Head of Household’s physical address listed on the membership application or in a nursing home.

·  I understand that Flight Plan benefits only apply when Care Flight, or a reciprocating program, transports a member. (See list of reciprocal programs below – subject to change)

·  I understand that my membership only covers Flight Plan.  I understand I have the ability to select both the Care Flight air medical transport membership and the Silver Saver for REMSA Health ground transport membership or just a single membership if desired.

·  I understand that the Flight Plan membership program may be cancelled at any time for any reason.

·  I understand that my membership is non-transferable and non-refundable and not tax deductible.

·  I understand that Medicaid/Medi-Cal recipients are not eligible for either Flight Plan membership due to their health care policies.  By completing this application, I attest that those persons listed in the application are not a Medicaid or Medi-Cal recipient.

·  I understand that Care Flight will bill and receive payment from my health care insurance company.  I also understand that if I receive payments for services from my health care insurer, I am responsible to immediately forward that payment onto Care Flight.

·  I understand that Care Flight will treat failure to forward Medicare or insurance payments onto Care Flight as insurance fraud and legal action may be taken.  I also understand that my failure to forward insurance or Medicare Payments will result in termination of my membership with Care Flight and I am responsible for full charges for services rendered.

·  I understand that the effective date for my membership is the date that Care Flight receives my completed application and membership fee plus a three day waiting period.  Memberships are effective for one year.

·  Care Flight is a member of the Association of Air Medical Membership Programs (AAMMP).  Your membership in “Flight Plan” will be honored for emergency air medical transportation by the following reciprocating programs (subject to change):

·          Air St. Luke’s – Boise, ID

·          Care Flight – Reno, NV

·          Enloe Flight Care – Chico, Ca

·          Life Flight Network – Aurora, OR