Island Air Ambulance 

Membership

An Island Air Ambulance Membership assures that you and your family can be transported with no out-of-pocket expense for medically necessary flights performed by Island Air Ambulance.  

Act now and get your membership at these special introductory prices!  

Health Insurance requirement:  Health insurance with an ambulance benefit is a requirement for membership and must be valid at the time of service.  Medicaid recipients, or those with no health insurance, while not eligible for membership, are still eligible for service.

[Prices subject to change without notice.]

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Select membership level

* Mandatory fields
* Membership level

The online payment portal on the next page allows you to use a paypal account, credit card, debit card or checking account.
You do not need a paypal account to pay, scroll thru until you find the pay with credit or debit card option.
Make sure to enter the correct billing address associated with your form of payment to avoid processing errors.

Please be sure to list the relationships of all applicants.


Incomplete applications may cause a delay in processing.

Vacation Memberships  - $25 (USD)
Great for visitors or summer residents.  Covers applicant, spouse or domestic partner and dependents claimed on income tax, for three continuous months.   Apply here.

Downloadable Membership Application for all levels available here.


Statement of Understanding

I apply for participation as a member in the Membership Program of Island Air.  I agree to the Island Air Membership Program Terms and Conditions described in the accompanying materials and on our website.  I verify that I am not a Medicaid beneficiary and that I do have health insurance.  I request payment of authorized Medicare or any other insurance benefits be made on my behalf to Island Air for any ambulance services provided to me by Island Air now, in the past, or in the future.  I understand that I am financially responsible for the services and supplies provided to me by Island Air regardless of my insurance coverage, and in some cases, I may be responsible for an amount in addition to that which was paid by my insurance.  I agree to immediately remit to Island Air any payments that I receive directly from my insurance or any source whatsoever for the services provided to me and I assign all rights to such payments to Island Air.  I authorize Island Air to appeal payment denials or other adverse actions on my behalf without further authorization and direct any holder of medical information or other relevant documentation about me to release such information to Island Air, its billing agents, the Centers for Medicare and Medicaid Services, and/or any other payers or insurers, and their respective agents or contractors as may be necessary to determine these or other benefits payable for any services provided to me by Island Air now, in the past, or in the future.  A copy of this form is valid as an original.  

By submitting a membership application online, I acknowledge I have read Island Air's Notice of Privacy Practices.

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