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Membership covers out-of-pocket costs like co-pays & deductibles.

Household Memberships include the main subscriber, spouse or domestic partner and anyone else residing at the residence.  All persons to be covered by the membership plan as residents (which includes college students through age 26 and foster children) must be listed on the Membership application and comply with all terms & conditions. Health insurance with an ambulance benefit is a requirement for membership and must be valid at the time of service. Household memberships do not cover visiting family members or other guests.

Please click here for a downloadable Membership application form to print. 

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Select membership level

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Medicare: Supplemental insurance plans may cover out-of-pocket co-pays and deductibles. Please check with your insurance carrier.

Medicaid (i.e. Apple Health) includes coverage for transports with no out-of-pocket cost to the recipient, therefore no membership is required unless there are also other types of insurance in your household.

Those with no health insurance, while not eligible for membership, are still eligible for service.

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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