Membership Agreement

This is not an application for an insurance policy. If you are already a current Silver Saver or Gold Saver member, you need not fill out the entire application. Please read the agreement thoroughly, follow the instructions and have those over age 18 in your household sign the application form and return it along with your membership fee.

		I understand that my Flight Plan membership fee covers my portion of Care Flight’s services that are applied to co-insurance or deductibles by insurance or Medicare for medically necessary transports. “Medically necessary” is defined as specific need of air ambulance transportation to the nearest medically appropriate hospital as requested by a physician or as directed by state/county protocols. I understand that Care Flight may require physician certification of medical necessity.
		I understand that Flight Plan is not an insurance policy nor is it meant to be a substitute for health insurance. 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 Care Flight because it determines that my air ambulance services were not medically necessary, I will be responsible for the payment of the fees for those services, less a 20% discount because I am a Flight Plan member.
		I understand that my Flight Plan membership covers those persons who permanently reside in my household and who are 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 a Flight Plan member is transported by Care Flight or a reciprocating program (see list of programs).
		I understand that Flight Plan membership does NOT cover the services of REMSA’s or SEMSA’s ground ambulance service.
		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.
		I understand that Medicaid/Medi-Cal recipients are not eligible for Flight Plan membership due to their own policies, and I verify that I am not a Medicaid/Medi-Cal recipient.
		I understand that the effective date for my membership is the date that Care Flight receives my completed and signed Membership Application and fee, and is effective for one year.
		ASSIGNMENT OF BENEFITS: I understand that my Flight Plan membership is not an insurance plan and that Care Flight will bill and receive payments from my insurer or third party (such as Medicare, Blue Cross, etc.). I hereby authorize all benefits be paid directly to Care Flight. If I have Medicare, I request that payment or authorized Medicare benefits be made on my behalf to Care Flight for any air ambulance service provided to me by Care Flight. If I receive payment from Medicare or my insurance company, I will immediately forward that payment to Care Flight. If I do not, I understand that my membership may be terminated and I will be billed full charges for Care Flight services. I acknowledge that I am responsible for payment of air ambulance services.
		LIFETIME SIGNATURE AUTHORIZATION. To facilitate processing, I authorize the release to the Centers for Medicare and Medicaid Services or other insurer of any medical information or documentation held by anyone necessary to process a claim now or in the future, and further assign and authorize such payments to Care Flight. I permit a copy of this authorization to be used in place of the original.
		The Flight Plan Membership Program is not insurance. I will not be covered if transported by an air ambulance company other than Care Flight or a reciprocating program. Air ambulances sent in an emergency are determined by the 911 Emergency System. The closest aircraft will be sent. This may also occur if Care Flight is unable to respond within a medically appropriate period due to all aircraft being on other calls, weather, or maintenance issues.

The Flight Plan Membership Program is not insurance. I will not be covered if transported by an air ambulance company other than Care Flight or a reciprocating program. Air ambulances sent in an emergency are determined by the 911 Emergency System. The closest aircraft will be sent. This may also occur if Care Flight is unable to respond within a medically appropriate period due to all aircraft being on other calls, weather, or maintenance issues.

REMSA/Care Flight is compliant with HIPAA regulations. A copy of our Notice of Privacy Practices is available upon request or by clicking here.

Each household member over the age of 18 must agree to the above terms.

Please follow the link below, fill in and print out the Membership Application. Each member must sign and date the application showing that you have read, understand and agree to the Silver Saver terms. Send the completed and signed application along with your payment to:

REMSA/Care Flight

450 Edison Way

Reno, NV 89502

450 Edison Way Reno, Nevada 89502 (775)858-5700 Fax (775)858-5720