ISLAND AIR AMBULANCE MEMBERSHIP PROGRAM
TERMS AND CONDITIONS
1) Purpose: A Membership program is designed to provide Island Air with immediate financial support from you in exchange for a reliable and available air ambulance service. In thanks for your Membership payment, Island Air will not charge any member for co-payment and deductible amounts that are otherwise billable on a per-transport basis, as allowed by law. Because insurance does not always cover the full cost of air ambulance service, you could be responsible for outstanding balances that insurance does not cover, and your Membership covers most of those balances for medically necessary emergency air ambulance services. This Membership is not designed to be an insurance contract of any type.
2) Membership: Members are entitled to unlimited use of Island Air fixed wing air ambulance for emergency transports, provided the transport is reasonable and medically necessary and all other coverage requirements are met, and based upon availability of resources, without being responsible for co-payment and deductible amounts that are typically charged to cover amounts that are not paid by insurance. This waiver of co-payment and deductible obligation only applies to persons listed on the Membership application. This Membership is non-refundable and non-transferable. This Membership program does not apply to persons without insurance coverage or to persons receiving medical assistance (Medicaid) benefits. Becoming a member does not grant any voting or participation rights in Island Air corporate activities.
3) Available Membership Plans: Membership is effective upon receipt by Island Air of the Membership application and fee and expires one year from that date, unless a 3 year membership is purchased. The following types of Membership plans exist:
a) Basic Membership Plan: Island Air Ambulance Membership covers the main subscriber, spouse or domestic partner and anyone else residing at the residence. All persons to be covered by the membership plan as residents (which includes college students through the age of 26 and foster children) must be listed on the Membership application and comply with all terms & conditions.
b) 3 Year Basic Membership Plan: Island Air Ambulance Membership covers the main subscriber, spouse or domestic partner and anyone else residing at the residence. All persons to be covered by the membership plan as residents (which includes college students through the age of 26 and foster children) must be listed on the Membership application and comply with all terms & conditions.
c) Family Vacation Plan: Covers those that a household plan would cover, but only for a continuous 3-month period of time. This plan is designed for seasonal visitors to the San Juan Islands.
4) Payment: Members are responsible for initial payment of the Membership fee as outlined in the Membership Application. Except for some additional payment obligations outlined in Paragraphs 5 and 6, the member will not be responsible for any other payments for covered ambulance services provided by Island Air. Island Air will submit bills directly to your insurance for payment of ambulance services that are provided. If a member receives payment for ambulance services directly from an insurance company, such payment must be turned over to Island Air. It is improper and illegal to keep reimbursement received for ambulance services provided by Island Air. Members are expected to cooperate with Island Air in all collection efforts, and recognize that Island Air may initiate legal action for failure to pay Island Air for amounts they may be responsible to pay. If you receive a bill from Island Air in error and have insurance that will cover the cost, please forward your insurance information to Island Air so that your insurance can be billed directly. If you ever feel that you are billed inappropriately please contact Island Air so that it can resolve the problem.
5) Transportation that is covered as part of this Membership:
a. Emergency Air Ambulance Transportation: I understand that emergency air ambulance transportation covered by this Membership is limited to medically necessary and reasonable emergency air ambulance transportation provided by Island Air to the nearest appropriate facility. This means that patient cost-sharing obligations for medically necessary and reasonable emergency air ambulance transportation by Island Air will be covered by your Membership fee without you incurring any additional out of pocket expenses.
6) Payment liabilities not covered under the Membership:
a. Non-Emergency and Schedule Air Ambulance Services: I understand that in addition to emergency services, Membership includes access to pre-scheduled, non-emergency and scheduled air ambulance transports that are medically necessary and reasonable (as determined by Island Air). Non-emergency and scheduled service is subject to availability of staff and equipment, and emergency transports always have priority. 24-hour advanced notice and physician authorization may be required for non-emergency services. This is an additional service that is available, but not guaranteed. Unlike with emergency services, members will be responsible for co-payment and deductible payments, as well as mileage costs and other services that are not covered under insurance. Pre-authorization and/or physician certification may be required to demonstrate that air ambulance transport is warranted. In the event that non-emergency air ambulance transport is not medically necessary, warranted, or properly authorized (as required by insurance), I understand that I may be responsible for the entire cost of the transport.
b. Transports Beyond the Closest Appropriate Facility: I understand that insurance pays for transport only to the closest appropriate facility. Any transportation beyond the closest appropriate facility at the request of me, my family, or my doctor, may make me responsible for additional payments that are not covered under my Membership. I understand that in these situations, I am responsible for such additional charges, and may or may not be advised of additional charges at the time of the transport.
c. Non-Covered Services: In cases where air ambulance transport is not medically necessary, or where there is the ability to take another form of transportation, or for non-transport or other non-covered services, I understand that I may be responsible for charges that are not covered by this membership.
d. Transports by Other Ambulance Services: I understand that this Membership only applies to emergency air transports provided by Island Air ambulances. In the event that another ambulance service with which I do not have a Membership conducts the transport, I will be responsible for co-payment and deductible amounts, and (if not covered by insurance) the full cost of the service.
Disclaimers:* This Membership program is not a contract for the provision of ambulance services.