Terms and conditions – consolidated

AirMedCare Network Terms and Conditions

AirMedCare Network is an alliance of affiliated air ambulance providers* (each a “Company“). An AirMedCare Network membership automatically enrolls you as a member in each Company’s membership program. Membership ensures the patient will have no out-of-pocket flight expenses if flown by a Company by providing prepaid protection against a Company’s air ambulance costs that are not covered by a member’s insurance or other benefits or third party responsibility, subject to the following terms and conditions:

1. Patient transport will be to the closest appropriate medical facility for medical conditions that are deemed by AMCN Provider attending medical professionals to be life- or limb-threatening, or that could lead to permanent disability, and which require emergency air ambulance transport. A patient’s medical condition, not membership status, will dictate whether or not air transportation is appropriate and required. Under all circumstances, an AMCN Provider retains the sole right and responsibility to determine whether or not a patient is flown.

2. AMCN Provider air ambulance services may not be available when requested due to factors beyond its control, such as use of the appropriate aircraft by another patient or other circumstances governed by operational requirements or restrictions including, but not limited to, equipment manufacturer limitations, governmental regulations, maintenance requirements, patient condition, age or size, or weather conditions. FAA restrictions prohibit most AMCN Provider aircraft from flying in inclement weather conditions. The primary determinant of whether to accept a flight is always the safety of the patient and medical flight crews. Emergent ground ambulance transport of a member by an AMCN Provider will be covered under the same terms and conditions.

3. Members who have insurance or other benefits, or third party responsibility claims, that cover the cost of ambulance services are financially liable for the cost of AMCN Provider services up to the limit of any such available coverage. In return for payment of the membership fee, the AMCN Provider will consider its air ambulance costs that are not covered by any insurance, benefits or third party responsibility available to the member to have been fully prepaid. The AMCN Provider reserves the right to bill directly any appropriate insurance, benefits provider or third party for services rendered, and members authorize their insurers, benefits providers and responsible third parties to pay any covered amounts directly to the AMCN Provider. Members agree to remit to the AMCN Provider any payment received from insurance or benefit providers or any third party for air medical services provided by the AMCN Provider, not to exceed regular charges. Neither the Company nor AirMedCare Network is an insurance company. Membership is not an insurance policy and cannot be considered as a secondary insurance coverage or a supplement to any insurance coverage. Neither the Company nor AirMedCare Network will be responsible for payment for services provided by another ambulance service.

4. Membership starts 15 days after the Company receives a complete application with full payment; however, the waiting period will be waived for unforeseen events occurring during such time. Members must be natural persons. Memberships are non-refundable and non-transferable.

5. Some state laws prohibit Medicaid beneficiaries from being offered membership or being accepted into membership programs. By applying, members certify to the Company that they are not Medicaid beneficiaries.

6. These terms and conditions supersede all previous terms and conditions between a member and the Company or AirMedCare Network, including any other writings, or verbal representations, relating to the terms and conditions of membership.

*Air Evac EMS, Inc. / Guardian Flight, LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These terms and conditions apply to all AirMedCare Network participating provider membership programs, regardless of which participating provider transports you.

v.11_2017

Ground Membership Terms and Conditions (Oregon)

City of Bend FireMed, Crescent RFPD, Blue Mountain Hospital Ambulance, Crook County Fire & Rescue, Harney District EMS, Klamath Falls District 1, Rocky Point and Chemult Rural Fire Protection District are voluntary ambulance membership programs operated by each individual agency, hereinafter referred to as FireMed.

• FireMed membership benefits include all persons who are permanent residents of the same single-family dwelling/ noncommercial residence living together as part of a family unit, but not to include roomers or boarders. Membership benefits are also extended to include household members living in substitute care (i.e. nursing homes) within your city and district ambulance service areas.
• The first person listed on the application form is designated as the “Primary Member.” Only those persons who meet the membership eligibility requirements AND are listed in the membership record at the time services are rendered are eligible for benefits.
• FireMed Membership is not an insurance policy but secondary to insurance carriers. All available insurances will be billed first. We will accept payment from insurance carriers as payment in full.
• I transfer directly to the FireMed agency my rights to ground medical insurance payments due to me. Such payments shall not exceed FireMed regular charges.
• Ground Memberships are honored by FireMed Membership programs of Oregon. Ground Membership covers ground ambulance charges only.
• Ground emergent medical transports are based on medical need, not membership status, and transport patients to the closest medically appropriate facility as requested by the physician. Non-emergency transports are not covered by this agreement.
• No refunds will be issued on membership purchases. Membership benefits are non-transferable.
• There is no grace period on the membership. Payment must be received by the due date to avoid lapse in benefits.
• New and lapsed membership benefits take effect 72 hours after receipt of completed enrollment with payment.

v.12_2018

ParaMed LifeCare Terms and Conditions

I hereby apply for membership in ParaMed LifeCare tor myself and eligible members who live at my address. I understand the enclosed fee provides emergency ambulance care and transportation within the Lower Umpqua Hospital Emergency Medical Service service area, including transport to Bay Area Hospital or Lower Umpqua Hospital and non-emergency and long distance ambulance service as noted below. Membership starts 15 days after the Company receives a complete application with full payment; however, the waiting period will be waived for unforeseen events occurring during such time. Members must be natural persons. Non-emergency ambulance service to hospitals, 24-hour emergency medical receiving facilities, nursing homes and adult foster care centers within 35 miles is covered when medically necessary as determined by a doctor and with prior authorization from your insurance company if required by them. Long distance transports of over 35 miles are not covered but will be considered to have 25% of the co-payment prepaid by this membership agreement. I understand that ParaMed LifeCare is not insurance but will provide ambulance service through the Lower Umpqua Hospital EMS and will bill whatever insurance or medical benefits I may have and is entitled to primary and secondary insurance payment. ParaMed LifeCare is in excess of any insurance or medical benefits which I may have. I further authorize the release of medical information for the purpose of ambulance insurance billing only. Should I or a family member receive payment from insurance or other medical benefits provider for ambulance service rendered by Lower Umpqua Hospital EMS, I will immediately forward such payment to Lower Umpqua Hospital. ParaMed LifeCare membership is not solicited from persons who receive welfare medical benefits and such membership constitutes a voluntary contribution only. I understand that violations of the terms of this agreement may result in immediate cancellation. This membership is non-refundable and non-transferable.

*DEFINITION OF FAMILY

LifeCare membership covers immediate family members living in the same household. The member, spouse, unmarried children under age 25 and other persons listed as legal dependents for income tax purposes are covered. Others not included in this definition are required to obtain their own separate membership.

MEMBER BENEFITS IN AREAS OUTSIDE OF LOCAL LIFECARE SERVICE AREA

Member benefits are extended to areas outside of the local LifeCare service area but within the State of Oregon. These benefits are limited to the terms of agreement in effect by each individual ParaMed or FireMed participating agency at the time benefits are used. Members who receive ambulance service from any other ParaMed or FireMed participating agency are eligible for benefits offered by that agency provided that: 1) a copy of the ambulance bill is submitted to the local ParaMed LifeCare within 30 days of receipt of bill, 2) the member agrees to abide by the participating agency’s terms of agreement. A current list of FireMed participating agencies is on file in the ParaMed LifeCare business office.

TO THE INSURANCE CARRIER

I authorize a copy of this agreement to be used in lieu of the original on file at the ParaMed LifeCare office.  The original may be furnished on request. I authorize payment of insurance benefits for ambulance service for  myself  or  family  members directly  to Lower Umpqua Hospital  ParaMed,  according  to the LifeCare  agreement  and  as itemized  on the  attached claims. I have  paid the co-payment for ambulance service to be rendered and expect your usual and customary ambulance reimbursement  on  my behalf  to be  sent  directly  to  the Lower Umpqua Hospital.