“Subscribing members” (all persons listed in your application materials) are entitled to the use of Classic Air Medical emergency transport aircraft, when medically necessary, and based upon availability of resources, without being responsible for co-payment and deductible amounts that are typically charged to cover amounts that are not paid by insurance. This waiver of copayment and deductible obligation only applies to persons listed on the membership application. This subscription program does not apply to persons receiving medical benefits. Membership benefits take effect one day after receipt by Classic Air Medical’s business office of a completed application and associated payment of the annual membership fee.

Subscribing Members are responsible for initial payment of the annual membership fee as outlined on these membership application materials. The member will not be responsible for any other payments for air ambulance services where insurance makes primary payment and you would not otherwise be responsible for co-payment and deductible payment. Classic Air Medical will submit bills directly to your insurance payment of air ambulance services that are provided. If a subscribing member receives payment for an air ambulance service directly from an insurance company, such payment must be turned over to Classic Air Medical . It is improper and illegal to keep reimbursement received for air ambulance provided by Classic Air Medical . Subscribing members are expected to cooperate with Classic Air Medical in all collection efforts, and recognize that Classic Air Medical may initiate legal action against a patient/subscriber for failure to pay Classic Air Medical for amounts he or she may be responsible for.

I understand that air ambulance transportation covered in this membership is limited to emergency transport to the closest appropriate medical facility that is deemed “medically necessary” by the applicable insurance plan in which I am enrolled.

I understand that membership includes access to pre-scheduled non-emergency air ambulance transport that is medically necessary (as determined by Classic Air Medical and/or applicable insurance). Non-emergency service is subject to availability of staff and equipment, and emergency transports always have priority. 24-hour advanced notice and physician authorization may be required for non emergency services. This is an additional service that is available, but not guaranteed based upon subscription membership. Preauthorization and/or physical certification may be required to demonstrate that air ambulance transport is warranted.

Service Area: Classic Air Medical will pick up patients for transport in Arizona, Idaho, Montana, New Mexico, Utah, Colorado, Idaho and Wyoming. Ground transportation may need to be provided by the patient/primary care provider to an airport that meets the requirements to support Classic Air Medical’s aircraft.