Membership Fees are $75 per household and cover all listed members of your immediate family so long as they remain residents in your household. Upon completion of the form below, you will be redirected to the Online Payment page for credit card payment. You may also remit a PERSONAL or COMPANY CHECK to the address below:
2530 East 5th St
Montgomery, AL 36107
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Upon completion of the application form, you will be able to pay for your application via Paypal on the confirmation page.
TERMS AND CONDITIONS
In consideration of the payment by the Member of the membership fee, AIRCARE ASSURANCE, a division of HAYNES LIFE FLIGHT, agrees to provide the following benefits, subject to the terms and condition specified herein:
“Members” shall include the individual who signed the Application (“Primary Member”) and all household members listed inthe Application, so long as such individuals reside at the same address as he Primary Member.
The membership fee constitutes prepayment by the Member of all deductible, copayment and other charges which are not paid by the Member’s health insurance, such as Medicare, a PPO, an HMO, or other third-party sources such as a homeowners or automobile policy (collectively, “Insurance”) for Covered Transports, as defined herein. HAYNES LIFE FLIGHT shall accept the amounts paid by the Member’s Insurance as payment in full for such transports. Members shall not incur any out of pocket costs for Covered Transports, except as provided in paragraph 3 below.
As a condition of receiving the full benefit of membership as provided in paragraph 2 above, a member must have Insurance for a Covered Transport. Members who do not have Insurance for a Covered Transport will receive a discount equal to 20% of HAYNES LIFE FLIGHT’s billed charge.
“Covered Transports” means only medically necessary air ambulance services provided by HAYNES LIFE FLIGHT to the closest appropriate hospital. Air ambulance transports which are determined by the Member’s primary Insurance not to be medically necessary are not Covered Transports. Subject to paragraph 2 above, the Member is responsible for all HAYNES LIFE FLIGHT billed charges for air medical services that are not Covered Transports.
Transports provided by other air medical providers or by ground providers are not covered, except for ground transports to or from HAYNES LIFE FLIGHT helicopters BY Haynes ground ambulance. HAYNES LIFE FLIGHT may not be available when requested due to factors beyond HAYNES LIFE FLIGHT’S control. For example, HAYNES LIFE FLIGHT’s aircraft may be occupied providing transports to other patients, or HAYNES LIFE FLIGHT may be unable to respond due to weather condition, maintenance requirements, governmental market restrictions or other factors.Further, HAYNES LIFE FLIGHT does not operate in all areas. Its service area is identified on the HAYNES LIFE FLIGHT website at http://www.haynes-ambulance.com.
As a condition of receiving membership benefits, the Member assigns and transfers to Haynes Life Flight all rights and benefits that the Member has under any and all Insurance, including but not limited to auto or homeowner’s insurance policies. The Member authorizes payment of all such benefits for air ambulance services to HAYNES LIFE FLIGHT. In the event payment is made to the Member of any other party on the Member’s behalf, the Member agrees to remit all such amounts promptly to HAYNES LIFE FLIGHT. Membership is not an insurance policy.
Membership shall become effective the day after AIRCARE ASSURANCE receives a complete application with full payment. Memberships are nonrefundable and nontransferable. The Member agrees to inform AIRCARE ASSURANCE within ten (10) days of any change in the Primary Member’s health insurance status (e.g., loss of coverage) or any change in the household Members covered by this membership. Persons who move out of the household are no longer covered and no benefits will be provided on their behalf.
As a member, if you receive a covered transport by Haynes Life Flight, Haynes Life Flight will accept the amount paid by your insurance carrier as payment in full. Therefore, you will not have any out-of-pocket expense. This can save you hundreds and sometimes thousands of dollars, since many insurance carriers do not cover the full cost of air ambulance services.