Mercy Flights services include Ground Ambulance within the Mercy Flights Jackson County assigned service area, Fixed Wing Air Ambulance within 1000 air miles of Medford, OR in the Western United States and Helicopter Ambulance within 150 air miles of Medford, OR in Southern Oregon and Northern California. I understand that Mercy Flights is not an insurance plan, and will bill whatever insurance or medical benefits I may have and/or be entitled to for services rendered by Mercy Flights. I also understand that Mercy Flights membership fees are non-refundable and there is a 30 day waiting period for member benefits to take effect. I understand that I will be responsible for any denied, disallowed, or non-medically necessary transports, as determined by my insurance company or other third party payer. If I do not have any insurance, I will be responsible for a portion of the bill. Should I or a covered family member receive payment from insurance or other medical benefits for ambulance services rendered by Mercy Flights, I will immediately forward such payment to Mercy Flights. The Mercy Flights membership is not solicited from persons who receive Medicaid medical benefits and such membership constitutes a voluntary contribution only. I understand that violation of such terms of this agreement or substantiated abuse of ambulance services may result in cancellation.
Eligible household members consist of the head of household, spouse, and immediate family members who live at the same physical location, are legal dependents (as determined by Internal Revenue Service guidelines) and are under 19 years of age. These legal dependents can include unmarried dependent fulltime students, under the age of 22, who reside at a different physical location or a spouse who resides in a care facility. Qualifying household members also include: disabled children, minor children of non-custodial parents, domestic partners, and dependent parents residing at the same physical location. Disabled children and dependent parents will continue their membership, if they move from the household into a care facility.
NOTICE: This Mercy Flights, Inc. Ambulance Plan is not an insurance program. Membership benefits are for services provided by Mercy Flights Inc. only. It will not compensate or reimburse another ambulance company that provides emergency transportation to you or your family. Other ambulance company transports may occur if Mercy Flights is unable to perform within a medically appropriate timeframe. This may occur, but is not limited to, a mechanical or maintenance problem or being on another call. This may also occur if the emergency location is outside of Mercy Flights’ assigned service area. If the other transporting ambulance company has a signed reciprocity agreement with Mercy Flights, that agency’s membership benefits will be applicable to the transport.
Mercy Flights, Inc. is based in Medford, Oregon and provides this ambulance membership program to cover only the provision of Helicopter and Fixed Wing Air Ambulance services for emergency medical responses and transportation. Helicopter response is limited to within 150 miles of Medford, Oregon or as regulated by NOR-CAL EMS. PLEASE CONTACT OUR OFFICE to determine Mercy Flights’ current primary and secondary response areas. Be aware that members should request Mercy Flights transport at the time of need, even if Mercy Flights is the secondary responder for the geographical area. Non-emergent or not medically necessary transportation is not included or covered by this plan. Mercy Flights membership fees are non-refundable.
Mercy Flights membership benefits apply only to services rendered by Mercy Flights for all eligible household members. Eligible household members consist of the head of household and immediate family members, living at the same physical location, who are legal dependents (as determined by Internal Revenue Service guidelines). These legal dependents can include unmarried students residing at a different physical location or a spouse residing in a care facility. Qualified household members also include: minor children of non-custodial parents, domestic partners, and parents who are previously listed as part of the original household membership, but have moved into a care facility.
California memberships are set according to the KNOX KEENE HEALTH CARE SERVICE PLAN ACT AMENDMENT TO TITLE 28, SECTION 1300.43.3 AMBULANCE PLANS CONDITIONAL EXEMPTION.
BEFORE YOU PURCHASE: If you are currently enrolled in a Health Maintenance Organization (HMO) or other health insurance, the benefits provided by an Ambulance Plan may duplicate the benefits provided by your HMO or other health insurance. If you have a question regarding whether your HMO or other health insurance offers benefits for ambulance services, you should contact that other company directly.
WARNING: This Mercy Flights, Inc. Ambulance Plan is not an insurance program. It will not compensate or reimburse another ambulance company that provides emergency transportation to you or your family. This may occur when the 911 Emergency System has independently determined that another company could provide more expeditious service or is next in the rotation to receive a call. This might also occur when Mercy Flights is unable to perform within a medically appropriate timeframe due to a mechanical or maintenance problem or being on another call.
COMPLAINTS: For complaints regarding this Ambulance Plan, first attempt to call Mercy Flights at 1-800-903-9000. If Mercy Flights fails to resolve the complaint to your satisfaction, contact the Department of Managed Health Care at 1-800-400-0815. The Department’s website is http://www.dmhc.ca.gov. You may obtain complaint forms and instructions online.
OPERATING UNDER CONDITIONAL EXEMPTION: This Ambulance Plan is operating pursuant to an exemption from the KNOX KEENE HEALTH CARE SERVICE PLAN ACT OF 1975 ( Health and Safety Code section 1340 et seq.).