TERMS
AND
CONDITIONS
LifeMed Individual Membership Summary of Terms and Conditions
24-HOUR MEDEVAC DISPATCH: 1-800-478-5433
- Membership Applicability. Membership applies to myself as the “Primary Member” as well as to members of my “Household” if such “Household Members” (both defined below) are added to the Membership and the appropriate fees are paid as set out below. “Household” and “Household Members” are defined as the Primary Member’s spouse or domestic partner, and dependent children under the age of 26 whom the Primary Member provides 50% or more for their support. Household Members must be added to the Membership at the time of application and the effective date of the Membership. In order for Membership to apply to anyone who joins my Household after the Membership goes into effect, I must first update my online Membership account or provide LifeMed with written notice of the new household member’s name, date of birth, relationship to me, and primary insurance information, and pay the applicable fee for such new Household member(s). Membership for any household members that are added will not become effective until I either update my online membership account or notify Member Services in writing of the addition. Newborns are automatically added as Household Members but require notification and payment to LifeMed within 30 days from the date of birth to continue coverage.
- Membership Fees. The current annual Membership fee of $149.00 covers the Primary Member and Household Members can be added for an additional $99 per family member.
- Requirement for Insurance Coverage. Membership only applies to myself and my added Household Members who are covered by an insurance policy that includes air and ground medical transport benefits, as listed on the Membership Enrollment Form. I represent and warrant that I and all Household Members have air and ground medical transport benefits with an insurance provider as indicated on the Membership Enrollment Form. I agree to notify LifeMed within ten business days of any change in my insurance or the insurance of any other Household Members enrolled in the Membership. This Membership is considered an insurance contract in the State of Alaska.
- Billing. If I receive medical transportation from LifeMed, LifeMed will bill my insurance or other responsible third party payor. Membership is secondary to insurance or coverage provided by another third party payor. LifeMed will accept the amount paid by my insurance or third party payor for any medically necessary transport. The Membership fee constitutes prepayment for the patient responsibility amount indicated by the insurance company’s explanation of benefit for all emergent and medically necessary air medical transport services provided to the closest most appropriate facility.
- Assignment of Rights. When LifeMed provides medical transportation, it provides value to members and incurs cost for itself. I and my Household Members hereby assign directly to LifeMed all rights to insurance or other payor payments that are due in order to compensate LifeMed for the cost it incurs in providing medical transportation service on behalf of myself or my added Household Members. I and any added Household Members will provide LifeMed with all necessary insurance provider or third party payor information, as well as all other information necessary to process such claims. I and any Household Member agree to turn over any payment(s) sent by insurance or third party payor for a LifeMed medical transport within ten (10) days of receiving payment.
- Potential Ineligibility for Individuals Covered Under Government Payor Programs or Health Share Plans. Per government regulations, individuals covered by certain government payor programs, including but not limited to Medicare, Medicaid, Tricare, etc., may not be eligible for Membership. Likewise, members of health share plans are generally not eligible for Membership. To the extent I have coverage under any such program/plan, I agree to contact the program/plan directly to determine if I am eligible for LifeMed Membership prior to applying and purchasing the Membership.
- Reservation of Rights, Term of Membership, and Free-Look Period. LifeMed reserves the right to decline acceptance of anyone in to its Membership program; however, once LifeMed receives the fully completed enrollment form and accepts payment of the Membership fee(s), Membership benefits will be effective immediately following receipt, unless LifeMed returns or refunds the Membership fee(s) or notifies me within 30 days that the Membership fee payment has not been accepted. Membership, including membership for Household Members, lasts for one year from the date of LifeMed’s acceptance of the Primary Member’s membership. I understand and acknowledge that I am entitled to a free-look period of ten (10) days following LifeMed’s acceptance of this Membership during which I may terminate and return the Membership by providing written notice to LifeMed with a full refund of any air ambulance service membership fee and the Membership will be deemed to have been void ab initio. If Membership is terminated pursuant to this free-look period, no membership benefits will apply to any transports or other services rendered by LifeMed to either myself or any added Household Members during the free-look period.
- Renewal and Grace Period. I understand and agree that it is my responsibility to contact LifeMed to renew this Membership 30 days prior to the enrollment anniversary. I further understand and agree that I am responsible for providing any changes to my account or insurance benefits, or providing confirmation that no changes have occurred. If auto-renewal is requested, the Membership will renew each year on the enrollment anniversary as long as all applicable fees are timely paid and I provide LifeMed with any changes to my account or provide confirmation that no changes have occurred. I understand and agree that the fees set out in this Membership are subject to increase by LifeMed, at LifeMed’s sole discretion, on each enrollment anniversary. Membership benefits for the Primary Member and all Household Members will automatically expire one year following the date of LifeMed’s acceptance of the Primary Member’s membership. However, I shall have a grace period of thirty (30) days following termination in which to pay for a renewal membership by paying LifeMed’s then current rate for such membership. I understand that if I or a added Household Member is transported by LifeMed and my Membership has expired, the Membership benefits will not apply to the transport and I and/or my Household members will be responsible for any related costs not covered by my insurance or third-party payer.
- Requirement of Medical Necessity. Membership benefits only apply to transports determined to be medically necessary as determined by the member’s primary insurer. Medical transports are based on medical need, not membership status, and transport will be made to the closest, medically appropriate facility as requested by a physician or medical professional. Members are responsible for the cost of any transports that are determined not medically necessary by the member’s primary insurer.
- No Guarantee of Transport. I understand and agree that air medical transport service by LifeMed cannot be guaranteed and may not be available due to various conditions, including but not limited to, weather conditions, geographic restraints, unavailability of aircraft due to maintenance or pilot shortages, lack of resources, emergency or disaster situations, legal and regulatory restraints, or commitment to another patient transport(s).
- Other Providers – No Benefit. I understand and agree that I and my Household Members will not receive benefits of the Membership program if transportation is made by an air ambulance company other than LifeMed.
- Incidental Ground Transportation. Membership benefits apply to ground ambulances operated by LifeMed where such ground transportation services are incidental to a covered air medical transport, such as for transportation between the aircraft and hospital, and when transfer between medical facilities is necessary.
- Non-transferability. Memberships are non-transferable. Memberships can be terminated by request of the Primary Member. Memberships are nonrefundable after expiration of the free-look period.
- Attorney Fees and Costs. In the event there is any litigation regarding this Membership and LifeMed is deemed the prevailing party, I agree to pay LifeMed’s reasonable actual costs and attorney fees.
LifeMed Group Corporate Membership Summary of Terms and Conditions
24-HOUR MEDEVAC DISPATCH: 1-800-478-5433
- Membership Applicability. Membership applies to me as a qualifying employee of the Company working in the State of Alaska. Membership will continue throughout the Term of the Company Agreement, regardless of any changes to my employment status with the Company. Membership is not transferrable or assignable. I also understand and agree that each person is only entitled to receive the benefits of one LifeMed membership for any given transport regardless of how many LifeMed memberships they may hold (g., if I concurrently have another LifeMed membership that I purchased individually or that was provided to me through another means, I understand that I will only be entitled to the benefits of one such membership in the event of a covered transport, and that I will not be entitled to any refunds, cash value equivalents, or duplication of benefits).
- Requirement for Insurance Coverage. Membership only applies if I am covered by an insurance policy that includes air and ground medical transport benefits. In accepting this Membership, I represent and warrant that I have air and ground medical transport benefits with a health insurance provider. I agree to notify LifeMed within ten (10) business days of any change in my insurance. This Membership is considered an insurance contract in the State of Alaska.
- Billing. If I receive medical transportation from LifeMed, LifeMed will bill my insurance or other responsible third-party payor. Membership is secondary to insurance or coverage provided by another third-party payor. LifeMed will accept the amount paid by my insurance or third-party payor for any medically necessary transport. The Membership fee paid by the Company constitutes prepayment for the patient responsibility amount indicated by the insurance company’s explanation of benefit for all emergent and medically necessary air medical transport services provided to the closest most appropriate facility.
- Assignment of Rights. When LifeMed provides medical transportation, it provides value to members and incurs cost for itself. In accepting this Membership, I hereby assign directly to LifeMed all rights to insurance or other payor payments that are due in order to compensate LifeMed for the cost it incurs in providing medical transportation service on my behalf. I also agree provide to LifeMed with all necessary insurance provider or third-party payor information, as well as all other information necessary to process such claims. I further agree to turn over any payment(s) sent to me by insurance or third-party payor for a LifeMed medical transport within ten (10) days of receiving payment.
- Potential Ineligibility for Individuals Covered Under Government Payor Programs and Health Share Plans. Per government regulations, individuals covered by certain government payor programs, including but not limited to Medicare, Medicaid, Tricare, etc., may not be eligible for Membership. Further, members of health share plans are generally not eligible for Membership. As such, I acknowledge and agree that to the extent I have coverage, or later obtain coverage during the Term, under any government payor program or through a health share plan, to promptly notify the Company and LifeMed as this may mean that I cannot accept Membership and related benefits.
- Term of Membership; Company’s Free-Look Period. The Term of this Membership is set out in the Company Agreement and will be communicated to me by the Company and LifeMed. My membership will automatically expire at the conclusion of the Term as set out in the Company Agreement. I also understand and acknowledge that the Company is entitled to a free-look period of ten (10) days following the Effective Date of the Company Agreement, during which time the Company may terminate the Company Agreement. If the Company were to terminate the Company Agreement during the free-look period, I understand and agree that my Membership will be deemed to have been void ab initio and that no membership benefits will apply to any transports or other services rendered by LifeMed to me during the free-look period.
- Requirement of Medical Necessity. Membership benefits only apply to transports determined to be medically necessary as determined by my primary insurer. Medical transports are based on medical need, not membership status, and transport will be made to the closest, medically appropriate facility as requested by a physician or medical professional. Members are responsible for the cost of any transports that are determined not medically necessary by the member’s primary insurer.
- No Guarantee of Transport. I understand and agree that air medical transport service by LifeMed cannot be guaranteed and may not be available due to various conditions, including but not limited to, weather conditions, geographic restraints, unavailability of aircraft due to maintenance or pilot shortages, lack of resources, emergency or disaster situations, legal and regulatory restraints, or commitment to another patient transport(s).
- Other Providers – No Benefit. I understand and agree that I will not receive benefits of the Membership program if transportation is made by an air ambulance company other than LifeMed.
- Incidental Ground Transportation. Membership benefits apply to ground ambulances operated by LifeMed where such ground transportation services are incidental to a covered air medical transport, such as for transportation between the aircraft and hospital, and when transfer between medical facilities is necessary.
- Attorney Fees and Costs. In the event there is any litigation regarding this Membership and LifeMed is deemed the prevailing party, I agree to pay LifeMed’s reasonable actual costs and attorney fees.
LifeMed Group 30 Day Visitor Membership Summary of Terms and Conditions
24-HOUR MEDEVAC DISPATCH: 1-800-478-5433
- Membership Applicability. Membership applies to myself individually. Membership is not transferrable or assignable.
- Membership Fees. The current Membership fee for a 30-Day Visitor Membership is $49.00.
- Requirement for Insurance Coverage. Membership only applies if I am covered by an insurance policy that includes air and ground medical transport benefits. In accepting this Membership, I represent and warrant that I have air and ground medical transport benefits with a health insurance provider. I agree to notify LifeMed within ten (10) business days of any change in my insurance. This Membership is considered an insurance contract in the State of Alaska.
- Billing. If I receive medical transportation from LifeMed, LifeMed will bill my insurance or other responsible third-party payor. Membership is secondary to insurance or coverage provided by another third-party payor. LifeMed will accept the amount paid by my insurance or third-party payor for any medically necessary transport. The Membership fee paid by the Company constitutes prepayment for the patient responsibility amount indicated by the insurance company’s explanation of benefit for all emergent and medically necessary air medical transport services provided to the closest most appropriate facility.
- Assignment of Rights. When LifeMed provides medical transportation, it provides value to members and incurs cost for itself. In accepting this Membership, I hereby assign directly to LifeMed all rights to insurance or other payor payments that are due in order to compensate LifeMed for the cost it incurs in providing medical transportation service on my behalf. I also agree provide to LifeMed with all necessary insurance provider or third-party payor information, as well as all other information necessary to process such claims. I further agree to turn over any payment(s) sent to me by insurance or third-party payor for a LifeMed medical transport within ten (10) days of receiving payment.
- Potential Ineligibility for Individuals Covered Under Government Payor Programs or Health Share Plans. Per government regulations, individuals covered by certain government payor programs, including but not limited to Medicare, Medicaid, Tricare, etc., may not be eligible for Membership. Likewise, members of health share plans are generally not eligible for Membership. To the extent I have coverage under any such program/plan, I agree to contact the program/plan directly to determine if I am eligible for LifeMed Membership prior to applying and purchasing the Membership.
- Reservation of Rights, Term of Membership, Grace Period, and Free-Look Period. LifeMed reserves the right to decline acceptance of anyone in to its Membership program; however, once LifeMed receives the fully completed enrollment form and accepts payment of the Membership fee(s), Membership benefits will be effective immediately following receipt. Membership under the 30-Day Visitor Membership shall commence on the date LifeMed accepts the Membership and lasts for the next thirty (30) days (the “Term”). The Membership will automatically expire at the conclusion of the Term. I shall have a grace period of thirty (30) days following termination in which to pay for a renewal membership by paying LifeMed’s then current rate for such membership. I understand that if I am transported by LifeMed and my Membership has expired, the Membership benefits will not apply to the transport and I will be responsible for any related costs not covered by my insurance or third-party payer. I understand and acknowledge that I am entitled to a free-look period of ten (10) days following LifeMed’s acceptance of this Membership during which I may terminate and return the Membership by providing written notice to LifeMed with a full refund of any air ambulance service membership fee and the Membership will be deemed to have been void ab initio. If Membership is terminated pursuant to this free-look period, no membership benefits will apply to any transports or other services rendered by LifeMed to me during the free-look period. Memberships are nonrefundable after expiration of the free-look period.
- Requirement of Medical Necessity. Membership benefits only apply to transports determined to be medically necessary as determined by the member’s primary insurer. Medical transports are based on medical need, not membership status, and transport will be made to the closest, medically appropriate facility as requested by a physician or medical professional. Members are responsible for the cost of any transports that are determined not medically necessary by the member’s primary insurer.
- No Guarantee of Transport. I understand and agree that air medical transport service by LifeMed cannot be guaranteed and may not be available due to various conditions, including but not limited to, weather conditions, geographic restraints, unavailability of aircraft due to maintenance or pilot shortages, lack of resources, emergency or disaster situations, legal and regulatory restraints, or commitment to another patient transport(s).
- Other Providers – No Benefit. I understand and agree that I and my Household Members will not receive benefits of the Membership program if transportation is made by an air ambulance company other than LifeMed.
- Incidental Ground Transportation. Membership benefits apply to ground ambulances operated by LifeMed where such ground transportation services are incidental to a covered air medical transport, such as for transportation between the aircraft and hospital, and when transfer between medical facilities is necessary.
- Attorney Fees and Costs. In the event there is any litigation regarding this Membership and LifeMed is deemed the prevailing party, I agree to pay LifeMed’s reasonable actual costs and attorney fees.