Caring-Heart Membership

Caring Heart Membership 2023 Renewal

Please join our Caring-Heart Membership Program

* Required information

Head of Household Member

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  • Gender

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  • Fee

    Type Fee

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Additional Household Members

You may add a maximum of 6

Caring-Heart Membership Terms and Conditions

  • PERSONS COVERED: This Agreement covers the household family members listed on my Application, so long as they remain full-time residents of the specified household. New residence family members may be added, family members may be deleted or the household location may be changed by written notice to CareFlite. Added members will be effective immediately as of the postmarked date on the envelope. I understand that Medicaid recipients are not permitted to enroll in this program. EFFECTIVE DATE: Memberships will be effective upon receipt of payment and application. BENEFITS: Payment of membership fee and compliance with the terms of this Agreement entitles members to the following benefits:

  • 1. Emergency air ambulance services: Members, who receive "medically necessary" advanced or basic life support emergency services from CareFlite as a result of an 'emergency medical condition', shall pay nothing out of pocket, except as specified herein. 2. Emergencies needing a higher level of care located further than 150 miles away from our helicopter service area, but in the U.S. and within 500 miles of DFW can be serviced by our Fixed Wing Air Ambulance. All medical transports must meet the medical criteria and be pre-approved by patient’s insurance carrier before services can be provided. Upon services being approved and used, the member will pay nothing out of pocket. If insurance coverage is denied then the member will be responsible for CareFlite’s standard charges for the services rendered less a 50% membership discount. 3. CareFlite Ground Ambulance will be available to members when they are within its service area. These benefits will follow the rules of the Air Ambulance Membersh

  • PAYMENT FOR SERVICES: I understand that I am responsible for payment for any services provided to me by CareFlite, but that my membership will assist me by discharging that part of my financial liability that is not covered by insurance for those CareFlite services specified in this Agreement. This benefit is subject to certain limitation specified in this agreement. As a condition of receiving this benefit, I hereby assign (hand over) to CareFlite all rights and benefits that I or the other family members of my residence have, under any and all medical, health, supplemental, worker’s compensation, liability, auto or homeowner’s insurance policies or plans, or from other third party payers or sources which provide coverage or would otherwise pay for air ambulance services. Such payment sources are collectively referred to in this agreement as ‘insurance.’ I authorize payment of all insurance benefits or payments to CareFlite.

  • I understand that CareFlite will, whenever it deems it feasible, file claims for and directly collect the benefits payable from insurance, up to the amount of CareFlite’s charges for its services. When requested by CareFlite, I agree to complete any forms and take any other reasonable action that may be necessary to collect such amounts. If I or anyone on my behalf receives any insurance or other third party payments for services provided by CareFlite, I will promptly forward those payments to CareFlite at 3110 S. Great Southwest Parkway, Grand Prairie, Texas 75052.

  • LIMITATIONS and CONDITIONS: Membership benefits extend to CareFlite’s critical care, advanced or basic life support air ambulance services staffed with Nurses, Paramedics and Pilot’s and Ground Ambulance staffed with quality trained Medics. Membership benefits are inapplicable to services rendered by any other provider. As a condition of receiving the benefits of membership with respect to any Air or Ground ambulance transport, a member with insurance must comply with all coverage conditions of their applicable insurance program for such transport. Some insurance programs require the insured person to obtain prior authorization of payment for non-emergency, yet medically necessary air ambulance services. Non-insured household family members will receive a 50% membership discount on CareFlite standard charges for the services rendered.

  • Some plans require certain documentation from the insured within a specified time limit, or the plans deny or reduce coverage for air ambulance services. In the event a member with insurance forfeits coverage by failing to comply with these types of requirements for a transport that would otherwise be covered by membership, member will then forfeit membership benefit by failing to comply with their insurance requirements and membership can be revoked. Air membership will be available 150 miles from DFW airport by helicopter and 150 miles but less than 500 miles from DFW Airport by fixed wing for emergencies needing a higher level of care, and in addition, Ground benefits will cover those members in CareFlite service areas where applicable.

  • The members must hold a membership that is in good standings at the time of services and the transport originates in CareFlite’s deemed service area and providing that CareFlite is the transporting agency. CareFlite reserves the right to deny or revoke any membership for a reasonable cause. If membership is revoked then all balances are due in full. CareFlite may terminate the membership program at any time upon notice to the members. If CareFlite terminates the program, members will have any unused, prorated portion of their annual membership fee returned. To protect member fees, CareFlite maintains a bond with Hartford Casualty, an A+ rated insurance company.

  • ELECTRONIC SIGNATURE By paying the CareFlite Membership Fee, I agree (on behalf of my family) to abide by the terms and wish to hereby apply for Air Membership in the CareFlite Caring-Heart Membership program for myself and members of my household listed on the Application, as set forth in this Agreement. I have reviewed the Caring-Heart Air Membership Agreement and agree to abide by the terms thereof. I request payment of authorized Medicare or other insurance benefits to me, or on my behalf, to be paid to CareFlite for any emergency services and supplies furnished to me by CareFlite. I authorize any holder of any of my medical information to release that information to the CMS, its agents and carriers, or CareFlite, in order to determine benefits payable on my behalf, now and in the future. This agreement and authorization is executed on my own behalf and on behalf of other members of my household, if they are minors or otherwise unable to sign.

  • I understand that under the State rule of 157.11 k, if I or a household member is a Medicaid recipient, then I am not allowed to have them on my Application, therefore I am stating that I have not listed on my application anyone that is a Medicaid recipient. If a family member becomes a recipient of Medicaid, I will notify CareFlite in writing of this life change immediately. I warrant that all the information in the Application is true and correct. CareFlite reserves the right to request documentation demonstrating the accuracy of such information. I acknowledge that membership in CareFlite Caring-Heart Membership program is simply a membership in a program sponsored by CareFlite, and thus, is not membership in CareFlite's non-profit corporate entity as the term membership is contemplated under the Texas Non-Profit Corporation Act.

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    I accept all of the Terms and Conditions of the Caring-Heart Membership Program.



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