Airlift Northwest Membership

By submitting your application, you acknowledge and agree to the following terms and conditions:

• Membership applies to me, my spouse or unmarried partner, and any children claimed as dependents on my current income tax return and all of whom who are covered by a health insurance product which includes air medical transport benefits, as listed on the enrollment form.
• Membership is considered an insurance product in the State of Alaska.
• I have air medical transport benefits with a health insurance company as indicated on the enrollment form. I agree to notify Airlift Northwest within five business days of any change in my health insurance or the health insurance of any other household members enrolled in the membership. Most health sharing companies accepted. Call 888-835-1599 for more information.
• If I receive an air medical transport by Airlift Northwest, Airlift Northwest will bill my health insurance or other responsible third party payer. My membership is secondary to health insurance or coverage provided by another third party payer. 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. I agree to cooperate with and provide my health insurance company any necessary requirements in order to process my insurance claim.
• When Airlift Northwest provides air medical transport, Airlift Northwest provides value to me and incurs cost for itself. By submitting my membership application or renewal, I hereby assign directly to Airlift Northwest all rights to insurance or other payer payments that are due to me in order to compensate Airlift Northwest for the cost it incurs in providing air transport service on my behalf. I agree to turn over any payment(s) sent to me by my insurance for Airlift Northwest air medical flight within ten days of receiving payment.
• Per government regulations, individuals covered by Medicaid are not eligible and should not apply. Airlift Northwest reserves the right to decline acceptance of anyone into its membership program; however, once Airlift receives the fully completed enrollment form and accepts payment of the membership fee, my membership benefits will be effective immediately following receipt unless Airlift Northwest returns or refunds my membership fee or notifies me that my membership fee payment has not been accepted.
• My membership benefits will automatically expire at the end of my enrollment period, unless payment of the next membership fee is received by Airlift Northwest within 30 days after expiration of my enrollment period.
• A spouse or unmarried partner and children who are or will be claimed as dependents on your current income tax return may be added to your membership. In order for my membership to apply to anyone who joins my household after the membership goes into effect, I must first provide Airlift Northwest with written notice of the new household members’ name, date of birth, relationship to me, and primary health insurance information. Newborns are members and require notification within 30 days from the date of birth to continue coverage. 
• Membership applies to emergent transports determined to be medically necessary as determined by the insured’s primary insurer. Membership does not apply to any scheduled transport or non-emergent transport. Emergent air 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. I am responsible for the cost of any transports that are determined not to be medically necessary or denied by my primary health insurance company.
• Air medical transport service by Airlift Northwest cannot be guaranteed due to weather conditions, geographic restraints or commitment to another patient transport. Membership covers Airlift Northwest air medical transport services and I agree that charges or fees for a ground ambulance transport are not included in my membership. I will not receive benefits of the membership program if transportation is made by an air ambulance company other than Airlift Northwest.
• Membership purchases are non-transferable. Memberships are non-refundable after 30 days from the date of purchase.
• In the event Airlift Northwest is compelled to institute action to enforce the terms of this membership agreement, I will be liable for attorneys’ fees, collection costs, interest at the statutory rate and all other costs and expenses which may be incurred.

Members acknowledge and agree to the above terms with signature on Airlift Northwest Membership brochure or with payment.

By submitting your application you acknowledge and agree to the following terms and conditions:

• Membership applies to me, my spouse or unmarried partner, and any children claimed as dependents on my current income tax return and all of whom who are covered by a health insurance product which includes air medical transport benefits, as listed on the enrollment form.
• Membership is not an insurance product
• I have air medical transport benefits with a health insurance company as indicated on the enrollment form. I agree to notify Airlift Northwest within five business days of any change in my health insurance or the health insurance of any other household members enrolled in the membership. Most health sharing companies accepted. Call 888-835-1599 for more information.
• If I receive an air medical transport by Airlift Northwest, Airlift Northwest will bill my health insurance or other responsible third party payer. My membership is secondary to health insurance or coverage provided by another third party payer. 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. I agree to cooperate with and provide my health insurance company any necessary requirements in order to process my insurance claim.
• When Airlift Northwest provides air medical transport, Airlift Northwest provides value to me and incurs cost for itself. By submitting my membership application or renewal, I hereby assign directly to Airlift Northwest all rights to insurance or other payer payments that are due to me in order to compensate Airlift Northwest for the cost it incurs in providing air transport service on my behalf. I agree to turn over any payment(s) sent to me by my insurance for Airlift Northwest air medical flight within ten days of receiving payment.
• Per government regulations, individuals covered by Medicaid are not eligible and should not apply. Airlift Northwest reserves the right to decline acceptance of anyone into its membership program; however, once Airlift receives the fully completed enrollment form and accepts payment of the membership fee, my membership benefits will be effective immediately following receipt unless Airlift Northwest returns or refunds my membership fee or notifies me that my membership fee payment has not been accepted.
• My membership benefits will automatically expire at the end of my enrollment period, unless payment of the next membership fee is received by Airlift Northwest within 14 days after expiration of my enrollment period.
• A spouse or unmarried partner and children who are or will be claimed as dependents on your current income tax return may be added to your membership. In order for my membership to apply to anyone who joins my household after the membership goes into effect, I must first provide Airlift Northwest with written notice of the new household members’ name, date of birth, relationship to me, and primary health insurance information. Newborns are members and require notification within 30 days from the date of birth to continue coverage. 
• Membership applies to emergent transports determined to be medically necessary as determined by the insured’s primary insurer. Membership does not apply to any scheduled transport or non-emergent transport. Emergent air 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. I am responsible for the cost of any transports that are determined not to be medically necessary or denied by my primary health insurance company.
• Air medical transport service by Airlift Northwest cannot be guaranteed due to weather conditions, geographic restraints or commitment to another patient transport. Membership covers Airlift Northwest air medical transport services and I agree that charges or fees for a ground ambulance transport are not included in my membership. I will not receive benefits of the membership program if transportation is made by an air ambulance company other than Airlift Northwest.
• Membership purchases are non-transferable. Memberships are non-refundable after 30 days from the date of purchase.
• In the event Airlift Northwest is compelled to institute action to enforce the terms of this membership agreement, I will be liable for attorneys’ fees, collection costs, interest at the statutory rate and all other costs and expenses which may be incurred.

Members acknowledge and agree to the above terms with signature on Airlift Northwest Membership brochure or with payment.