Air St. Luke's Membership Agreement

Membership in Air St. Luke’s is a way of showing your support for the specialized critical care transport services provided by St. Luke’s Medical Center. Initial annual membership is $50 per family per year. In recognition of your support, Air St. Luke’s will accept payment from your primary insurance as payment in full for any medically necessary Air St. Luke’s air or ground transport. This benefit also extends to other medically necessary air ambulance services provided by members of the Association of Air Medical Membership Programs (AAMMP).

I understand that:

• Air St. Luke’s Membership is not an insurance or investment program and has no guaranteed benefit. The purpose of membership is to support Air St. Luke’s.

• The membership benefits are for myself, my spouse and our dependent children under age 23 (those claimed on my income tax return) and listed on the enrollment form.

• The Air St. Luke’s Membership benefit is secondary to all other insurance payments.

• Air St. Luke’s will accept payment from insurance carriers as payment in full.

• I transfer directly to St. Luke’s Medical Center my rights to air medical insurance payments due me. Such payments shall not exceed Air St. Luke’s regular charges.

• The benefits of Air St. Luke’s Membership cover
air ambulance and ground ambulance charges for medically necessary services provided by Air St. Luke’s or AAMMP affiliates only. A physician or emergency medical personnel only may determine medical necessity.

• New member enrollment and benefits take effect three days after receipt of a completed enrollment form with payment, and continue for one year thereafter.

• Both ground and air emergent medical transports are based on medical need not Membership status. Not every illness or injury requires air transport. Patients will be transported to the closest, medically appropriate facility as determined by a physician or emergency personnel.

• While every reasonable effort will be made, service cannot always be guaranteed due to weather conditions or commitment to another transport.

• Memberships are non-refundable and neither
transferable nor assignable to other individuals.

• I will receive a membership card that I should carry. This will show my membership status in Air St. Luke’s and help to ensure benefits in the event emergency transport is required.