**Attention California Residents A Word from the California Department of Managed Health Care
(A) BEFORE YOU PURCHASE: If you are currently enrolled in a health maintenance organization (HMO) or other health insurance, the benefits provided by an Ambulance Plan may duplicate the benefits provided by your HMO or other health insurance. If you have a question regarding whether your HMO or other health insurance offers benefits for ambulance services, you should contact that other company directly.
(B) WARNING: This Ambulance Plan is not an insurance program. It will not compensate or reimburse another ambulance company that provides emergency transportation to you or your family. This may occur when the 911 Emergency System has independently determined that another company could provide more expeditious service or is next in the rotation to receive a call. This might also occur when this Ambulance Plan is unable to perform within a medically appropriate timeframe due to a mechanical or maintenance problem or being on another call.
(C) COMPLAINTS: For complaints regarding this Ambulance Plan, or if you have questions regarding the Plan, first attempt to call REACH/CALSTAR/Cal-Ore at 1.800.793.0010. If REACH/CALSTAR/Cal-Ore fails to resolve the complaint to your satisfaction, contact the Department of Managed Health Care at 1-888-466-2219. The Department’s website is http://www.healthhelp.ca.gov. You may obtain complaint forms and instructions online.
(D) OPERATING UNDER CONDITIONAL EXEMPTION: This Ambulance Plan is operating pursuant to an exemption from the Knox-Keene Health Care Service Plan Act of 1975 (Health and Safety Code section 1340 ct seq.).
By typing your initials in the box below, you agree that you have read and understand the statements above.
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; provided, however, that the memberships obtained through a member’s employer will start in accordance with the terms of the specific employer plan; provided further, any 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.
AMCN Fly-U-Home and Fly-U-Home International* Master Terms and Conditions
The following terms and conditions apply to both AMCN Fly-U-Home and Fly-U-Home International memberships.
1. Qualifications, Limitations and Exclusions. Membership is subject to the following qualifications, limitations and exclusions:
Waiting Periods. For the first 30 days of membership, a member may not be eligible for a transport due to illness or injury if the member was hospitalized for the same or a related condition within 30 days prior to the membership effective date.
Ineligible and Excluded Transports. A member being evaluated for or on an organ transplant list prior to enrollment will not be entitled to a transport for conditions related to that transplant. A member who is hospitalized at the time of enrollment will not be eligible for transport benefits for that hospitalization and may not be accepted for membership entirely.
Maximum Number of Transports. Membership covers up to two separate transports per year per membership (in total for all members covered under one membership); however, if multiple members who are covered under one membership require simultaneous transport, then each such member will be limited to that one transport.
Locations Inaccessible by Fixed Wing Aircraft. Both the originating and receiving hospital must be reasonably accessible by ground ambulance to transport the member to and from an airfield capable of accommodating an AirMed or one of its authorized affiliates aircraft. The cost associated with transportation from isolated areas or islands to an airport accessible to AirMed aircraft is not included in the membership and will be the responsibility of the member. Membership benefits do not include helicopter transportation.
High Risk / Safety Medical Restrictions. In conjunction with FAA, U.S. State Department and other regulatory standards, and AirMed safety standards, a member will not be entitled to air medical transport if the member’s illness or injury is a result of or is contributed to by the following: (i)suicide or attempted suicide or intentional self-injury; (ii) a member’s own criminal or felonious act; (iii) actions taken while the member is in a state of insanity; (iv) war, invasion, civil war or terrorism; or (v) contagious airborne pathogens. A member suffering from a psychiatric or mental disorder that is not manageable and will not allow safe transport within the confines of the ground ambulance and aircraft may not be transported. A member beyond the second trimester of pregnancy may not be transported if the transport request relates to the pregnancy.
Term; Cancellation; No Refunds. The length of the membership term will be as specified in the membership application and will begin on the enrollment date, which is the date on which the enrollment application is received and payment is successfully processed. A renewal within a current membership term extends the existing expiration date of the membership by the membership term selected; such renewal term begins the day after the current term ends. When an expired membership is renewed, the new membership term as selected by the member, will begin on the purchase date of the renewal.
AirMed reserves the right to terminate any membership immediately if (i) the annual billing is not paid in full, in accordance with the payment plan that the member selects or (ii) AirMed does not receive payment for other reason.
2. Any and all matters arising out of or relating to the membership program, these terms and conditions, and/or the subject matter hereof shall be governed by, construed, and enforced in accordance with the laws of the United States of America (including without limitation, the Federal Arbitration Act) and, to the extent not preempted by Federal law, the laws of the State of Alabama without regard to conflicts or choice of law principles, regardless of the legal theory upon which such matter is asserted. Outside of these terms and conditions, Federal law preempts state and local laws, regulations, and other provisions, including common law duties that relate to rates, routes, or services of an air carrier. To the extent a state or political subdivision thereof makes the incorporation of common law duties or state law in contracts optional, AirMed and you agree that this contract does not incorporate any such common law duties or state laws.
3. ARBITRATION AGREEMENT. Any controversy or claim arising out of or relating to the membership program, these terms and conditions, and/or the subject matter hereof shall be resolved by binding arbitration by a single arbitrator pursuant to the Consumer Arbitration Rules of the American Arbitration Association (“Rules”), as modified by these terms and conditions. The place of arbitration will be Birmingham, Alabama. The judgment on any award rendered by the arbitrator may be entered in any court having jurisdiction thereof. THERE SHALL BE NO RIGHT OR AUTHORITY FOR ANY CLAIMS TO BE ARBITRATED ON A CLASS ACTION, JOINT OR CONSOLIDATED BASIS OR ON BASES INVOLVING CLAIMS BROUGHT IN A PURPORTED REPRESENTATIVE CAPACITY ON BEHALF OF OTHER MEMBERS OR OTHER PERSONS. THE ARBITRATOR MAY AWARD RELIEF ONLY IN FAVOR OF THE INDIVIDUAL PARTY SEEKING RELIEF AND ONLY TO THE EXTENT NECESSARY TO PROVIDE RELIEF WARRANTED BY THAT INDIVIDUAL PARTY’S CLAIM. The arbitrator is not authorized to award attorney’s fees and costs or equitable relief. In the event the prohibition on class arbitration or any other provision in this arbitration agreement is deemed invalid or unenforceable, then the remaining provisions of these terms and conditions will remain in full force and effect. In the event of any dispute between the parties, you agree to first contact AirMed and make a good faith effort to resolve the dispute before resorting to arbitration under these terms and conditions.
These terms and conditions supersede all previous terms and conditions between a member and AirMed, including any other writings, or verbal representations, relating to the terms and conditions of membership. These terms and conditions may be modified or amended only in writing signed by the President of AirMed, and may not be modified or amended orally, by trade usage or by course of conduct or dealing.
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AirMedCare Network* Fly-U-Home U.S. Domestic Membership Specific Terms and Conditions
The following terms and conditions apply to AirMedCare Network Fly-U-Home membership only.
1. Member Eligibility. A member must be a natural person who resides in the Contiguous 48 States, meaning the United States of America, excluding the states of Alaska and Hawaii, and excluding all territories and possessions. A member’s residence must be listed on the member’s enrollment application. Requests for changes to a member’s residence must be submitted in writing to AirMed. The benefits of the membership extend to the designated primary member and all persons who dwell in a shared living space with the primary member and who are named in the enrollment application. Membership commences after a completed enrollment application and full payment has been received.
2. Air Medical Transport: Arrangements, Suitability and Additional Passengers. If (1) an AirMedCare Network Fly-U-Home member is admitted to a hospital in the Contiguous 48 States that is more than 150 nautical miles (or approximately 172.6 statute miles) from the member’s residence and (2) it is determined by the member’s physician and AirMed’s medical director that the member’s medical condition is stable enough to allow air transport but that medical escort is required, then, at the member’s request, AirMed will provide the member with private air medical transport or, if appropriate, commercial airline transport with medical escort. Transport will be provided on a bedside- to-bedside basis to a hospital of the member’s choice that has accepted the member as a patient and is within the locality of the member’s residence, subject to the membership terms and conditions.
3. Transport of Mortal Remains. If a member dies within the Contiguous 48 States while traveling more than 150 nautical miles (or approximately 172.6 statute miles) from the member’s residence, at the request of the member’s family, AirMed will arrange for the return of the member’s mortal remains to a funeral facility in the city of the member’s residence within the Contiguous 48 States.
* * * *
Fly-U-Home International* Specific Terms and Conditions
The following terms and conditions apply to Fly-U-Home International membership only.
1. Member Eligibility. A member must reside in the United States. References to “United States” in these terms and conditions and the description of benefits means the 50 United States, but no other United States territories or possessions. A member’s residence must be listed on the member’s enrollment application. Requests for changes to a member’s residence must be submitted in writing to AirMed. If for any reason the law of another country is found to apply to a membership, then such membership will be void and the member’s sole remedy will be a refund of the membership fee applicable to such membership. Members must be natural persons.
2. Air Medical Transport: Arrangements, Suitability and Additional Passengers. AirMed will make all arrangements for each air medical transport, including timing of the transport, type of aircraft, etc. This is a membership program that provides pre-paid medical transportation and is not an insurance plan. AirMed will not reimburse members for medical, medical transport or related expenses they incur on their own.
Decisions regarding urgency of transport, the best timing and the most suitable means of transportation will be made by the AirMed medical department after consultation with the local attending physician and the member’s receiving physician. AirMed membership does not cover emergent patient transports. If emergent medical treatment or transportation is needed, a member should contact appropriate local authorities for assistance. If, after a member receives such local emergent medical treatment or transportation while traveling more than 150 miles from the member’s residence, the member is admitted to a local hospital, then the member may qualify for repatriation benefits under the AirMed membership. In addition, a member with mild lesions, simple injuries such as sprains, simple fractures or mild conditions which can be treated by local doctors and do not prevent the member from continuing his or her trip or returning home does not qualify for air medical transport. All decisions made by the AirMed medical department are final.
Due to the limited medical facilities and testing available on cruise ships, in some cases the AirMed Medical Director may require the member to be admitted to a hospital on-shore before dispatching the AirMed aircraft.
3. Qualifications, Limitations and Exclusions. Membership is subject to the following qualifications, limitations and exclusions:
Ineligible and Excluded Transports. A member traveling outside of the United States for the sole purpose of seeking medical treatment, whether inpatient or outpatient, experimental or otherwise, will not be eligible for air medical transport benefits for that specific medical condition.
Extended Travel Limitation. AirMed membership is valid for unlimited U.S. travel and international travel with a limit of 90 days of unbroken travel per trip. For international travel in excess of 90 days of unbroken travel per trip, AirMed offers an Expatriate membership.
High Risk / Safety Travel Restrictions. Due to the high risk of sending U.S. registered aircraft and personnel into countries or geographic regions where the U.S. State Department, Department of Transportation, or the Federal Aviation Administration (FAA) has issued travel restrictions, membership services are not available in these areas.
* AirMedCare Network® is a registered service mark of Air Medical Group Holdings LLC. All AMCN Fly-U-HomeSM and Fly-U-Home International membership benefits are offered and provided by AirMed International LLC, an FAA Part 135 operator. All aircraft services are provided by AirMed International LLC, an FAA Part 135 operator, EagleMed LLC, an FAA Part 135 operator, both subsidiaries of Air Medical Group Holdings LLC, or a certified FAA Part 135 substitute air carrier engaged by AirMed International LLC.
AirMedCare Network Terms and Conditions
AirMedCare Network (“AMCN”) is an alliance of affiliated emergency air ambulance providers* (each a Provider). Your AMCN membership automatically enrolls you as a member in each Provider’s membership program. Membership ensures that you will have no out-of-pocket flight expenses if flown by a Provider by providing prepaid protection against a Provider’s air ambulance costs that are not covered by any insurance, benefits, or third-party responsibility available to you, subject to the following terms and conditions:
*Air Evac EMS, Inc. / Guardian Flight, LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These terms and conditions apply to all AMCN participating provider membership programs, regardless of which participating provider transports you.
Alaska Terms and Conditions
AirMedCare Network (“AMCN”) is an alliance of affiliated emergency air ambulance providers* (each a Provider). Guardian Flight LLC is the AirMedCare Network provider in Alaska. Your AMCN membership automatically enrolls you as a member in each Provider’s membership program. Membership ensures that you will have no out-of-pocket flight expenses if flown by a Provider by providing prepaid protection against a Provider’s air ambulance costs that are not covered by any insurance, benefits, or third-party responsibility available to you, subject to the following terms and conditions:
*Air Evac EMS, Inc. / Guardian Flight, LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These terms and conditions apply to all AMCN participating provider membership programs, regardless of which participating provider transports you.
AirMedCare Network (“AMCN”) is an alliance of affiliated emergency air ambulance providers* (each a Provider). Your AMCN membership automatically enrolls you as a member in each Provider’s membership program. Membership ensures that you will have no out-of-pocket flight expenses if flown by a Provider by providing prepaid protection against a Provider’s air ambulance costs that are not covered by any insurance, benefits, or third-party responsibility available to you, 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 the 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. Emergent ground ambulance transport of a member by an AMCN Provider, in connection with an emergent air ambulance transport by a Provider, will be covered under these same terms and conditions.
2. AMCN Provider air ambulance services may not be available when requested due to factors beyond the Provider’s 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.
3. Members who have any insurance or other benefits available to them, or third party responsibility (or liability) claims, that cover in any way the cost of ambulance services are financially liable for the cost of AMCN Provider services up to the limit of any such available coverage or recovery. 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 other third-party responsibility available to the member to have been fully prepaid. “Insurance” or “benefits” means any and all types of insurance or benefits without any limitation. By way of example only, such “insurance” or “benefits” include medical benefits available under health insurance, automobile insurance, homeowners insurance, workers compensation, and government insurance or benefits programs. Further, the terms “insurance” or “benefits” include any insurance or benefits that are owned by a member (or that are written or held in a member’s name), as well as any insurance or benefits owned by someone else (or that are written or held in someone else’s name) that provide coverage, to any extent, for the services provided by the AMCN Provider to a member. “Third-party responsibility” means any amounts that any third-party is required to pay to a member because of or related to the AMCN Provider’s services rendered to the member. The AMCN Provider reserves the right to seek payment directly from any available insurance, benefits provider, or third party for services rendered to a member (to the same extent it could do so for any non-member patient), and members authorize all available insurers, benefits providers, and responsible third parties to pay any covered amounts directly to the AMCN Provider.
4. Members agree to remit to the AMCN Provider any payment received from any insurance, benefit providers, or any third party for any services provided by the AMCN Provider, not to exceed the amount charged by the AMCN Provider, including (but not limited to) instances in which payment for an AMCN Provider’s services is made via settlement with any insurers, benefit providers, or third parties found responsible for a member’s injury or condition leading to the air medical services provided by the AMCN Provider. Remitting such payments are not member out-of-pocket expenses because such payments originated from third parties only because of the air medical services provided to the member. Failure by a member to remit such payments constitutes a material breach of these terms and conditions and authorizes the Provider to seek full payment for its services from the member.
5. Neither the Providers nor AMCN 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 Providers nor AMCN will be responsible for payment for services provided by another ambulance service.
6. Membership starts 15‡ days after AMCN 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.
7. Some state laws prohibit Medicaid beneficiaries from being offered membership or being accepted into membership programs. By applying, members certify to the Providers that they are not Medicaid beneficiaries.
8. LIMITATION OF LIABILITY. THE LIABILITY OF AMCN AND THE PROVIDERS, AND THE DAMAGES AVAILABLE TO A MEMBER, FOR BREACH OF THESE TERMS AND CONDITIONS IS LIMITED TO ACTUAL DAMAGES IN AN AMOUNT NOT TO EXCEED (A) ANY AMOUNT ACTUALLY RECEIVED BY AMCN OR ANY PROVIDER IN VIOLATION OF THESE TERMS AND CONDITIONS AND (B) THE MEMBERSHIP FEE PAID BY THE MEMBER FOR THE APPLICABLE MEMBERSHIP TERM. IN NO EVENT SHALL AMCN OR ANY PROVIDER BE LIABLE TO A MEMBER UNDER THESE TERMS AND CONDITIONS PURSUANT TO ANY CONTRACT, NEGLIGENCE, STRICT LIABILITY, TORT, OR OTHER LEGAL OR EQUITABLE THEORY FOR ANY INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES OF ANY NATURE WHATSOEVER, ARISING OUT OF OR IN CONNECTION WITH THE MEMBERSHIP PROGRAM OR THESE TERMS AND CONDITIONS, EVEN IF AMCN OR A PROVIDER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. THE MEMBER ACKNOWLEDGES AND AGREES THAT THE LIMITATIONS OF LIABILITY SET FORTH IN THESE TERMS AND CONDITIONS REFLECT AN ALLOCATION OF RISK SET FORTH IN THESE TERMS AND CONDITIONS AND THAT, IN THE ABSENCE OF SUCH LIMITATIONS, THESE TERMS AND CONDITIONS WOULD BE SUBSTANTIALLY DIFFERENT.
9. Any and all matters arising out of or relating to the AMCN membership program, these terms and conditions, and/or the subject matter hereof shall be governed by, construed, and enforced in accordance with the laws of the United States of America (including without limitation, the Federal Arbitration Act) and, to the extent not preempted by Federal law, the laws of the State of Missouri without regard to conflicts or choice of law principles, regardless of the legal theory upon which such matter is asserted. Outside of these terms and conditions, Federal law preempts state and local laws, regulations, and other provisions, including common law duties that relate to rates, routes, or services of an air carrier. To the extent a state or political subdivision thereof makes the incorporation of common law duties or state law in contracts optional, the Providers and you agree that this contract does not incorporate any such common law duties or state laws.
10. DISPUTE RESOLUTION. In the event of any controversy, dispute or claim arising out of or relating to the AMCN membership program, these terms and conditions, and/or the subject matter hereof, the Parties shall use their best efforts to resolve such controversy, dispute or claim through mediation administered by the American Arbitration Association before resorting to litigation, arbitration, or any other dispute resolution procedure. The place of mediation will be within the State of Wyoming. If the Parties are unable to reach a resolution through mediation, either Party may seek judicial relief in a court of competent jurisdiction or the Parties may agree to voluntarily submit the dispute to arbitration for resolution pursuant to the Wyoming Arbitration Act. THERE SHALL BE NO RIGHT OR AUTHORITY FOR ANY CLAIMS TO BE ARBITRATED OR LITIGATED ON A CLASS ACTION, JOINT OR CONSOLIDATED BASIS OR ON BASES INVOLVING CLAIMS BROUGHT IN A PURPORTED REPRESENTATIVE CAPACITY ON BEHALF OF OTHER MEMBERS OR OTHER PERSONS. THE ARBITRATOR OR JUDGE, AS APPLICABLE, MAY AWARD RELIEF ONLY IN FAVOR OF THE INDIVIDUAL PARTY SEEKING RELIEF AND ONLY TO THE EXTENT NECESSARY TO PROVIDE RELIEF WARRANTED BY THAT INDIVIDUAL PARTY’S CLAIM. Neither the arbitrator or judge, as applicable, will be authorized to award attorney’s fees, costs or equitable relief. In the event that this class waiver or any other provision in this Section 10 is deemed invalid or unenforceable, then the remaining provisions of these terms and conditions will remain in full force and effect. In the event of any dispute between the parties, you agree to first contact the Provider or AMCN and make a good faith effort to resolve the dispute before resorting to mediation, litigation, or arbitration under these terms and conditions.
11. These terms and conditions supersede all previous terms and conditions between a member and the Providers or AMCN, including any other writings, or verbal representations, relating to the terms and conditions of membership. These terms and conditions may be modified or amended only in writing signed by the President or a Vice President of AMCN or a Provider, and may not be modified or amended orally, by trade usage or by course of conduct or dealing.
*Air Evac EMS, Inc. / Guardian Flight, LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These terms and conditions apply to all AMCN participating provider membership programs, regardless of which participating provider transports you.
‡In Nebraska and Wyoming, waiting periods are not allowed; however, a member cannot purchase a membership at the time of transport.
AGREEMENT FOR MEMBERSHIP: This Air Ambulance Membership Plan (“Plan”) Coverage Agreement (“Agreement”) is entered into between Guardian Fight LLC, 10888 S 300 W, South Jordan, UT 84095, REACH Air Medical Services, LLC and the individual signatory (“Primary Member”) on the Membership Plan Application (“Application”). The Membership Office doing business as AirMedCare Network (“AMCN”) is located at 1800 Air Medical Drive, West Plains, MO 65775. AMCN can be reached by phone at 800-793-0010, Monday-Friday, 8:00am-8:00pm CST. Additional information available at www.AirMedCareNetwork.com.
By signing the Application, Primary Member agrees, on behalf of myself and the residents of my household listed on the Application, to abide by the AMCN membership terms and conditions, which will commence when AMCN receives my application and payment, and will expire the following year at midnight on the last day of the month payment is received. There is a 90 day grace period for renewal applications.
PERSONS COVERED: The Plan covers Primary Member and the residents of Member’s household listed in the Application, so long as they remain full-time residents of the specified household. Dependent children who are away at school are included as long as they retain the Primary Member’s residence as their primary residence. New household members may be added, household members may be deleted, or the household location may be changed by written or verbal notice by the Member to AMCN, effective the day following receipt by AMCN of such notice. All persons covered by the Plan shall be referred to herein as “Plan Members” or “Members”. References to “I” or “me” and similar references shall be construed as including all Members.
CONDITIONS OF MEMBERSHIP: As a condition of obtaining the benefits of membership and Plan coverage, Primary Member must submit a completed, accurate Application and pay AMCN a membership fee in the amount specified in the Application.
PAYMENT FOR SERVICES: I understand that I am responsible for payment for any services provided to me by Guardian Flight, REACH, or any other AMCN provider, but that my membership in the Plan will assist me by discharging that part of my financial liability that is not covered by any insurance, benefits or third party responsibility for those AMCN provider services. This membership benefit is subject to certain limitations specified in this Agreement. As a condition of receiving this membership benefit, I hereby assign to Guardian Flight and REACH all rights and benefits that I or the other Members in my household 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 provided to me. Such payment sources are collectively referred to in this Agreement as “Insurance and TPL”. I authorize payment of all Insurance and TPL benefits or payments for ambulance services provided to me by Guardian Flight or REACH to Guardian Flight or REACH.
CANCELATION of SERVICES: A Wyoming resident can cancel membership at any time. If canceled within 30 days of the date of this letter, the member will receive a full refund. Any request of cancelation after 30 days of this letter will result in a pro-rated refund.
BENEFITS: Payment of the membership fee and compliance with the terms of this Agreement entitle Members to the following benefits within the Service Area as specified below:
LIMITATIONS and EXCLUSIONS: Membership benefits extend to medically necessary emergency rotary wing (helicopter) and fixed wing (airplane) air ambulance services provided by an AMCN provider in the Service Area as described below. Membership benefits are provided for an AMCN provider emergency ground ambulance services, if provided as a means of facilitating their air ambulance services. Membership benefits will also extend to AMCN providers in the AMCN Service Area described below. AMCN providers shall apply the medical necessity standard of the Medicare program. Medicaid participants are not eligible for membership.
Guardian Flight/REACH Wyoming SERVICE AREA: The service area for Guardian Flight/REACH includes the following counties in Wyoming: Albany, Big Horn, Carbon, Campbell, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Laramie, Lincoln, Natrona, Niobrara, Park, Platte, Sheridan, Sublette, Sweetwater, Teton, Uinta, Washakie and Weston
AMCN SERVICE AREA: The service area for other AMCN providers includes parts of the following states: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia and Wyoming.
SERVICE AREA IMPORTANT INFORMATION: In an emergency and if the member is outside of the air ambulance membership organization’s service area, air ambulance services may be provided by another air ambulance provider or air ambulance membership organization, and the benefits of this air ambulance membership organization will not apply to the services provided by another air ambulance provider.
WYOMING MUNCIPALITY COVERAGE: Members may be covered by an air ambulance membership organization under a membership provided by a governmental entity. In Wyoming, the following municipalities have a membership plan: Washakie County, WY and Upper Wind River Valley Ambulance Association.
TERMINATION AND RENEWAL OF COVERAGE: AMCN may terminate this Agreement and the participation of any Members in the Plan for failure to comply with the terms of this Agreement. Any Service Area may be changed at any time without notice. AMCN reserves the right to discontinue the Plan at any time upon notice to Members. In such event, AMCN shall return a pro rata portion of the membership fee. AMCN also reserves the right to unilaterally modify the terms of this Plan, including but not limited to the membership fee charged to Members who join or renew their membership after the effective date of such change. Subject to foregoing, AMCN shall renew membership on an annual basis upon completion by a Member of an Application or renewal Application and payment of the applicable Membership Fee. Renewal contracts may include changes in coverage.
IMPORTANT INFORMATION: The membership program is not insurance coverage. If eligible and covered under Medicare, the member may already be covered for air ambulance services and should consult with a representative of the Medicare program to determine what services may be available under Medicare.
MEMBERSHIP RATES AND TERMS: Membership rates and terms are provided below. Members will be notified of any changes to the rates and terms available in Wyoming.
Discounted rates available through business plans.
AMCN Fly-U-Home and Fly-U-Home International* Master Terms and Conditions
The following terms and conditions apply to both AMCN Fly-U-Home and Fly-U-Home International memberships.
Ineligible and Excluded Transports: A member being evaluated for or on an organ transplant list prior to enrollment will not be entitled to a transport for conditions related to that transplant. A member who is hospitalized at the time of enrollment will not be eligible for transport benefits for that hospitalization and may not be accepted for membership entirely.
Maximum Number of Transports: Membership covers up to two separate transports per year per membership (in total for all members covered under one membership); however, if multiple members who are covered under one membership require simultaneous transport, then each such member will be limited to that one transport.
Locations Inaccessible by Fixed Wing Aircraft: Both the originating and receiving hospital must be reasonably accessible by ground ambulance to transport the member to and from an airfield capable of accommodating an AirMed or one of its authorized affiliates aircraft. The cost associated with transportation from isolated areas or islands to an airport accessible to AirMed aircraft is not included in the membership and will be the responsibility of the member. Membership benefits do not include helicopter transportation.
High Risk / Safety Medical Restrictions: In conjunction with FAA, U.S. State Department and other regulatory standards, and AirMed safety standards, a member will not be entitled to air medical transport if the member’s illness or injury is a result of or is contributed to by the following: (i)suicide or attempted suicide or intentional self-injury; (ii) a member’s own criminal or felonious act; (iii) actions taken while the member is in a state of insanity; (iv) war, invasion, civil war or terrorism; or (v) contagious airborne pathogens. A member suffering from a psychiatric or mental disorder that is not manageable and will not allow safe transport within the confines of the ground ambulance and aircraft may not be transported. A member beyond the second trimester of pregnancy may not be transported if the transport request relates to the pregnancy.
Term; Cancellation; No Refunds: The length of the membership term will be as specified in the membership application and will begin on the enrollment date, which is the date on which the enrollment application is received and payment is successfully processed. A renewal within a current membership term extends the existing expiration date of the membership by the membership term selected; such renewal term begins the day after the current term ends. When an expired membership is renewed, the new membership term as selected by the member, will begin on the purchase date of the renewal.
AirMed reserves the right to terminate any membership immediately if (i) the annual billing is not paid in full, in accordance with the payment plan that the member selects or (ii) AirMed does not receive payment for other reason.
These terms and conditions supersede all previous terms and conditions between a member and AirMed, including any other writings, or verbal representations, relating to the terms and conditions of membership. These terms and conditions may be modified or amended only in writing signed by the President of AirMed, and may not be modified or amended orally, by trade usage or by course of conduct or dealing.
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AirMedCare Network* Fly-U-Home U.S. Domestic Membership Specific Terms and Conditions
The following terms and conditions apply to AirMedCare Network Fly-U-Home membership only.
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Fly-U-Home International* Specific Terms and Conditions
The following terms and conditions apply to Fly-U-Home International membership only.
Decisions regarding urgency of transport, the best timing and the most suitable means of transportation will be made by the AirMed medical department after consultation with the local attending physician and the member’s receiving physician. AirMed membership does not cover emergent patient transports. If emergent medical treatment or transportation is needed, a member should contact appropriate local authorities for assistance. If, after a member receives such local emergent medical treatment or transportation while traveling more than 150 miles from the member’s residence, the member is admitted to a local hospital, then the member may qualify for repatriation benefits under the AirMed membership. In addition, a member with mild lesions, simple injuries such as sprains, simple fractures or mild conditions which can be treated by local doctors and do not prevent the member from continuing his or her trip or returning home does not qualify for air medical transport. All decisions made by the AirMed medical department are final.
Due to the limited medical facilities and testing available on cruise ships, in some cases the AirMed Medical Director may require the member to be admitted to a hospital on-shore before dispatching the AirMed aircraft.
Ineligible and Excluded Transports: A member traveling outside of the United States for the sole purpose of seeking medical treatment, whether inpatient or outpatient, experimental or otherwise, will not be eligible for air medical transport benefits for that specific medical condition.
Extended Travel Limitation: AirMed membership is valid for unlimited U.S. travel and international travel with a limit of 90 days of unbroken travel per trip. For international travel in excess of 90 days of unbroken travel per trip, AirMed offers an Expatriate membership.
High Risk / Safety Travel Restrictions: Due to the high risk of sending U.S. registered aircraft and personnel into countries or geographic regions where the U.S. State Department, Department of Transportation, or the Federal Aviation Administration (FAA) has issued travel restrictions, membership services are not available in these areas.
* AirMedCare Network® is a registered service mark of Air Medical Group Holdings LLC. All AMCN Fly-U-HomeSM and Fly-U-Home International membership benefits are offered and provided by AirMed International LLC, an FAA Part 135 operator. All aircraft services are provided by AirMed International LLC, an FAA Part 135 operator, EagleMed LLC, an FAA Part 135 operator, both subsidiaries of Air Medical Group Holdings LLC, or a certified FAA Part 135 substitute air carrier engaged by AirMed International LLC.
AirMedCare Network Terms and Conditions
AirMedCare Network (“AMCN”) is an alliance of affiliated emergency air ambulance providers* (each a Provider). Your AMCN membership automatically enrolls you as a member in each Provider’s membership program. Membership ensures that you will have no out-of-pocket flight expenses if flown by a Provider by providing prepaid protection against a Provider’s air ambulance costs that are not covered by any insurance, benefits, or third-party responsibility available to you, subject to the following terms and conditions:
*Air Evac EMS, Inc. / Guardian Flight, LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These terms and conditions apply to all AMCN participating provider membership programs, regardless of which participating provider transports you.
AMCN Fly-U-Home and Fly-U-Home International* Master Terms and Conditions
The following terms and conditions apply to both AMCN Fly-U-Home and Fly-U-Home International memberships.
Ineligible and Excluded Transports: A member being evaluated for or on an organ transplant list prior to enrollment will not be entitled to a transport for conditions related to that transplant. A member who is hospitalized at the time of enrollment will not be eligible for transport benefits for that hospitalization and may not be accepted for membership entirely.
Maximum Number of Transports: Membership covers up to two separate transports per year per membership (in total for all members covered under one membership); however, if multiple members who are covered under one membership require simultaneous transport, then each such member will be limited to that one transport.
Locations Inaccessible by Fixed Wing Aircraft: Both the originating and receiving hospital must be reasonably accessible by ground ambulance to transport the member to and from an airfield capable of accommodating an AirMed or one of its authorized affiliates aircraft. The cost associated with transportation from isolated areas or islands to an airport accessible to AirMed aircraft is not included in the membership and will be the responsibility of the member. Membership benefits do not include helicopter transportation.
High Risk / Safety Medical Restrictions: In conjunction with FAA, U.S. State Department and other regulatory standards, and AirMed safety standards, a member will not be entitled to air medical transport if the member’s illness or injury is a result of or is contributed to by the following: (i)suicide or attempted suicide or intentional self-injury; (ii) a member’s own criminal or felonious act; (iii) actions taken while the member is in a state of insanity; (iv) war, invasion, civil war or terrorism; or (v) contagious airborne pathogens. A member suffering from a psychiatric or mental disorder that is not manageable and will not allow safe transport within the confines of the ground ambulance and aircraft may not be transported. A member beyond the second trimester of pregnancy may not be transported if the transport request relates to the pregnancy.
Term; Cancellation; No Refunds: The length of the membership term will be as specified in the membership application and will begin on the enrollment date, which is the date on which the enrollment application is received and payment is successfully processed. A renewal within a current membership term extends the existing expiration date of the membership by the membership term selected; such renewal term begins the day after the current term ends. When an expired membership is renewed, the new membership term as selected by the member, will begin on the purchase date of the renewal.
AirMed reserves the right to terminate any membership immediately if (i) the annual billing is not paid in full, in accordance with the payment plan that the member selects or (ii) AirMed does not receive payment for other reason.
These terms and conditions supersede all previous terms and conditions between a member and AirMed, including any other writings, or verbal representations, relating to the terms and conditions of membership. These terms and conditions may be modified or amended only in writing signed by the President of AirMed, and may not be modified or amended orally, by trade usage or by course of conduct or dealing.
* * * *
AirMedCare Network* Fly-U-Home U.S. Domestic Membership Specific Terms and Conditions
The following terms and conditions apply to AirMedCare Network Fly-U-Home membership only.
* * * *
Fly-U-Home International* Specific Terms and Conditions
The following terms and conditions apply to Fly-U-Home International membership only.
Decisions regarding urgency of transport, the best timing and the most suitable means of transportation will be made by the AirMed medical department after consultation with the local attending physician and the member’s receiving physician. AirMed membership does not cover emergent patient transports. If emergent medical treatment or transportation is needed, a member should contact appropriate local authorities for assistance. If, after a member receives such local emergent medical treatment or transportation while traveling more than 150 miles from the member’s residence, the member is admitted to a local hospital, then the member may qualify for repatriation benefits under the AirMed membership. In addition, a member with mild lesions, simple injuries such as sprains, simple fractures or mild conditions which can be treated by local doctors and do not prevent the member from continuing his or her trip or returning home does not qualify for air medical transport. All decisions made by the AirMed medical department are final.
Due to the limited medical facilities and testing available on cruise ships, in some cases the AirMed Medical Director may require the member to be admitted to a hospital on-shore before dispatching the AirMed aircraft.
Ineligible and Excluded Transports: A member traveling outside of the United States for the sole purpose of seeking medical treatment, whether inpatient or outpatient, experimental or otherwise, will not be eligible for air medical transport benefits for that specific medical condition.
Extended Travel Limitation: AirMed membership is valid for unlimited U.S. travel and international travel with a limit of 90 days of unbroken travel per trip. For international travel in excess of 90 days of unbroken travel per trip, AirMed offers an Expatriate membership.
High Risk / Safety Travel Restrictions: Due to the high risk of sending U.S. registered aircraft and personnel into countries or geographic regions where the U.S. State Department, Department of Transportation, or the Federal Aviation Administration (FAA) has issued travel restrictions, membership services are not available in these areas.
* AirMedCare Network® is a registered service mark of Air Medical Group Holdings LLC. All AMCN Fly-U-HomeSM and Fly-U-Home International membership benefits are offered and provided by AirMed International LLC, an FAA Part 135 operator. All aircraft services are provided by AirMed International LLC, an FAA Part 135 operator, EagleMed LLC, an FAA Part 135 operator, both subsidiaries of Air Medical Group Holdings LLC, or a certified FAA Part 135 substitute air carrier engaged by AirMed International LLC.