Cal-Ore Life Flight Membership Agreement/Flyer and One Page Applications for Chamber Members

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Jennifer Hart jennifer.hart@amgh.us

Garberville Chamber of Commerce_AMCN Affinity Group Membership.pdf,Garberville Chamber of Commerce_One Page Application.pdf,Garberville Chamber of Commerce Flyer.pdf

Mar 10

to chamber

Hi there Cinnamon:

It was great to meet you on Friday night.

As promised attached please find an updated agreement, please initial pages 1,2 and 3 and sign page three, and scan and email back to me - or you can fax back to Head Office:

Attention Jennifer Rackely

Fax: 417-257-2863

I have also attached an electronic version of our membership showing your chamber discount and a flyer. You can use both of these as email blasts to all chamber members.

I would also like to discuss advertising options with the chamber and also want to make sure that we are current with our membership dues. If we are not you can email me an invoice and I will process for payment. If you do not accept credit card payments, then please attach a w-9 for me to submit for a check to be cut.

If you have any questions please give me a call.

Have a great day.

Jennifer Hart, REACH for Life and Cal-Ore Life Flight Membership Sales Manager

(530) 510-2915 Cell

www.reachair.com

www.cal-ore.com

3 Attachments

Garberville Chamber of Commerce_AMCN Affinity Group Membership.pdf

216 KB

Garberville Chamber of Commerce_One Page Application.pdf

1.1 MB

Garberville Chamber of Commerce Flyer.pdf

477 KB

Reply to all

Forward

garbervilleredwayareachamber garbervilleredwayareachamber@gmail.com

Mar 11

to Jennifer

Thank you Jennifer, it was great to meet you as well. Your membership is current, would you like me to add you as a contact in the membership, so you receive our monthly e-newsletter? I will get this information out and the form back to you ASAP.

Have a great day!

Cinnamon

On Mon, Mar 10, 2014 at 2:58 PM, Jennifer Hart <jennifer.hart@amgh.us> wrote:

Hi there Cinnamon:

It was great to meet you on Friday night.

As promised attached please find an updated agreement, please initial pages 1,2 and 3 and sign page three, and scan and email back to me - or you can fax back to Head Office:

Attention Jennifer Rackely

Fax: 417-257-2863

I have also attached an electronic version of our membership showing your chamber discount and a flyer. You can use both of these as email blasts to all chamber members.

I would also like to discuss advertising options with the chamber and also want to make sure that we are current with our membership dues. If we are not you can email me an invoice and I will process for payment. If you do not accept credit card payments, then please attach a w-9 for me to submit for a check to be cut.

If you have any questions please give me a call.

Have a great day.

Jennifer Hart, REACH for Life and Cal-Ore Life Flight Membership Sales Manager
(530) 510-2915 Cell

www.reachair.com

www.cal-ore.com

Cinnamon Paula

Executive Director

Garberville Redway Area Chamber of Commerce

PO Box 445/782 Redwood Drive

Garberville, Ca 95542

(707)923-2613

chamber@garberville.org

www.garberville.org

Google Maps - Maps from this email

Forward

garbervilleredwayareachamber garbervilleredwayareachamber@gmail.com

Mar 11

to Jennifer

I also want to add that we are the Garberville Redway Area Chamber of Commerce, not just Garberville. We incorporate all of Southern Humboldt county into our membership area.

Cinnamon

On Tue, Mar 11, 2014 at 11:13 AM, garbervilleredwayareachamber <garbervilleredwayareachamber@gmail.com> wrote:

Thank you Jennifer, it was great to meet you as well. Your membership is current, would you like me to add you as a contact in the membership, so you receive our monthly e-newsletter? I will get this information out and the form back to you ASAP.
Have a great day!
Cinnamon

On Mon, Mar 10, 2014 at 2:58 PM, Jennifer Hart <jennifer.hart@amgh.us> wrote:

Hi there Cinnamon:

It was great to meet you on Friday night.

As promised attached please find an updated agreement, please initial pages 1,2 and 3 and sign page three, and scan and email back to me - or you can fax back to Head Office:

Attention Jennifer Rackely

Fax: 417-257-2863

I have also attached an electronic version of our membership showing your chamber discount and a flyer. You can use both of these as email blasts to all chamber members.

I would also like to discuss advertising options with the chamber and also want to make sure that we are current with our membership dues. If we are not you can email me an invoice and I will process for payment. If you do not accept credit card payments, then please attach a w-9 for me to submit for a check to be cut.

If you have any questions please give me a call.

Have a great day.

Jennifer Hart, REACH for Life and Cal-Ore Life Flight Membership Sales Manager
(530) 510-2915 Cell

www.reachair.com

www.cal-ore.com

--
Cinnamon Paula
Executive Director

Garberville Redway Area Chamber of Commerce

PO Box 445/782 Redwood Drive

Garberville, Ca 95542
(707)923-2613
chamber@garberville.org

www.garberville.org

Cinnamon Paula

Executive Director

Garberville Redway Area Chamber of Commerce

PO Box 445/782 Redwood Drive

Garberville, Ca 95542

(707)923-2613

chamber@garberville.org

www.garberville.org

Forward

Jennifer Hart jennifer.hart@amgh.us

Garberville Chamber of Commerce Flyer.pdf,Garberville Chamber of Commerce_One Page Application.pdf,Garberville Chamber of Commerce_Cal-Ore Life Flight.pdf

Mar 11

to me

Hi there Cinnamon.

Absolutely please add me onto the news blast.

I have attached corrected flyer, one page app and agreement to include Redway Area - good catch tks.

Look forward to seeing the new eblast with our info in it. Thank you.

Jennifer Hart, REACH for Life and Cal-Ore Life Flight Membership Sales Manager

(530) 510-2915 Cell

www.reachair.com

www.cal-ore.com

From: garbervilleredwayareachamber [garbervilleredwayareachamber@gmail.com]
Sent: Tuesday, March 11, 2014 1:13 PM
To: Jennifer Hart
Subject: Re: Cal-Ore Life Flight Membership Agreement/Flyer and One Page Applications for Chamber Members

Have a great day!

Cinnamon

On Mon, Mar 10, 2014 at 2:58 PM, Jennifer Hart <jennifer.hart@amgh.us> wrote:

Hi there Cinnamon:

It was great to meet you on Friday night.

As promised attached please find an updated agreement, please initial pages 1,2 and 3 and sign page three, and scan and email back to me - or you can fax back to Head Office:

Attention Jennifer Rackely

Fax: 417-257-2863

I have also attached an electronic version of our membership showing your chamber discount and a flyer. You can use both of these as email blasts to all chamber members.

I would also like to discuss advertising options with the chamber and also want to make sure that we are current with our membership dues. If we are not you can email me an invoice and I will process for payment. If you do not accept credit card payments, then please attach a w-9 for me to submit for a check to be cut.

If you have any questions please give me a call.

Have a great day.

Jennifer Hart, REACH for Life and Cal-Ore Life Flight Membership Sales Manager
(530) 510-2915 Cell

www.reachair.com

www.cal-ore.com

Cinnamon Paula

Executive Director

Garberville Redway Area Chamber of Commerce

PO Box 445/782 Redwood Drive

Garberville, Ca 95542

(707)923-2613

chamber@garberville.org

www.garberville.org

3 Attachments

Garberville Chamber of Commerce Flyer.pdf

480 KB

Garberville Chamber of Commerce_One Page Application.pdf

1.2 MB

Garberville Chamber of Commerce_Cal-Ore Life Flight.pdf

327 KB

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cost thousands of dollars, and may not be covered in full by your insurance plan.

AirMedCare Network providers are happy to offer a broad membership plan that covers the remaining

balance of your transport after your insurance plan has paid, leaving you with no out-of-pocket air medical

transport expenses. And, as a member, the AirMedCare Network provides you with reciprocity among more

than 200 helicopter and airplane base locations coast-to-coast, across 28 states. Thus, you could be flown by

any one of the AirMedCare Network partners and experience the same benefits (i.e. no out-of-pocket expenses

for a medically necessary flight).

MEMBERSHIP

PROVIDING YOU WITH PEACE-OF-MIND

Become a MEMBER TODAY!

Call your local Membership Manager

Jennifer Hart

530.510.2915

1.800.793.0010 • www.cal-ore.com

In a medical emergency, every second counts…especially when transporting patients who are far away

from adequate medical treatment. No one knows that better than the flight crews at Cal-Ore Life Flight,

an emergency air ambulance program with over three decades of experience.

Cal-Ore Life Flight medical transport teams are on duty 24-hours a day, 365 days a year at ALL of our

base locations in order to assist the communities we serve. In addition to our outstanding critical care air

transport services, the CAL-ORE Life Flight membership is one more way we serve the communities. By

offering this beneficial membership program, all members can utilize the option of our lifesaving medical

transport without financial worry. The Cal-Ore Life Flight commitment to excellence is far reaching,

and our Membership Program is yet another extension of our commitment to you.

Cal-Ore Life Flight is proud to be a part of the AirMedCare Network

1 of 1

Page 1 of 1

Questions? Call Membership Sales Manager

Jennifer Hart ● 530-510-2915

or visit www.airmedcarenetwork.com

Quick STEP 1 Member Contact Information

By applying for membership, I agree to Cal-Ore’s terms and conditions.

Initials: Today's Date:

month

First Name: Last Name:

Physical Address:

City: State: Zip:

Home Phone: Cell Phone:

E-Mail Address: County:

Date of Birth:

Quick STEP 2 List Other Persons In Household and Date of Birth

First Name Last Name

month

First Name Last Name

month

If more space is needed please attach an additional sheet and detail the full name and date of birth for each member.

X / /

day year

Mailing Address:

month

/ /

day year

year day

day year

/ /

First Name Last Name

month day year

/ /

( M / F ) Do you live within the City Limits?

( M / F )

Yes No

A Cal-Ore Life Flight LLC (“Company”) membership ensures

the patient will have no out-of-pocket flight expenses if flown

by the Company or another AirMedCare Network participating

provider (together with the Company, each an “AMCN Provid- er”) by providing prepaid protection against AMCN Provider

emergent air ambulance costs that are not covered by a mem- ber’s insurance or other benefits or third party responsibility,

subject to the following terms and conditions:

Patient transport will be to the closest appropriate medi- cal facility for medical conditions that are deemed by

AMCN Provider attending medical professionals to be

life- or limb-threatening, or that could lead to permanent

disability, and which require emergency air ambulance

transport. A patient’s medical condition, not membership

status, will dictate whether or not air transportation is

appropriate and required. Under all circumstances, an

AMCN Provider retains the sole right and responsibility

to determine whether or not a patient is flown.

AMCN Provider air ambulance services may not be

available when requested due to factors beyond its

control, such as use of the appropriate aircraft by anoth- er patient or other circumstances governed by operation- al requirements or restrictions including, but not limited

to, equipment manufacturer limitations, governmental

regulations, maintenance requirements, patient condi- tion, age or size, or weather conditions. FAA restrictions

prohibit most AMCN Provider aircraft from flying in in- clement weather conditions. The primary determinant of

whether to accept a flight is always the safety of the

patient and medical flight crews. Emergent ground

ambulance transport of a member by an AMCN Provider

will be covered under the same terms and conditions.

Members who have insurance or other benefits, or third

party responsibility claims, that cover the cost of ambu- lance services are financially liable for the cost of AMCN

Provider services up to the limit of any such available

coverage. In return for payment of the membership fee,

the AMCN Provider will consider its air ambulance costs

that are not covered by any insurance, benefits or third

party responsibility available to the member to have

been fully prepaid. The AMCN Provider reserves the

right to bill directly any appropriate insurance, benefits

provider or third party for services rendered, and mem- bers authorize their insurers, benefits providers and

responsible third parties to pay any covered amounts

directly to the AMCN Provider. Members agree to remit

to the AMCN Provider any payment received from insur- ance or benefit providers or any third party for air medi- cal services provided by the AMCN Provider, not to

exceed regular charges. Neither the Company nor

AirMedCare Network is an insurance company. Mem- bership is not an insurance policy and cannot be consid- ered as a secondary insurance coverage or a supple- ment to any insurance coverage. Neither the Company

nor AirMedCare Network will be responsible for

payment for services provided by another ambu- lance service.

Membership starts 15 days after the Company receives

a complete application with full payment; however, the

waiting period will be waived for unforeseen events

occurring during such time. Members must be natural

persons. Memberships are non-refundable and non- transferable.

Some state laws prohibit Medicaid beneficiaries from

being offered membership or being accepted into mem- bership programs. By applying, members certify to the

Company that they are not Medicaid beneficiaries.

These terms and conditions supersede all previous

terms and conditions between a member and the Com- pany or AirMedCare Network, including any other writ- ings, or verbal representations, relating to the terms and

conditions of membership.

One Time transfer from credit card.



Quick STEP 3 Membership and Payment Options

(select one)

Credit Card Number

Signature

Expires 3 digit code on back of

    



Check or Money Order Number

BEFORE YOU PURCHASE: If you are currently enrolled in a health maintenance organization (HMO) or other health insurance, the benefits

provided by REACH may duplicate the benefits provided by your HMO or other health insurance. If you have a questions regarding whether your

HMO or other health insurance offers benefits for ambulance services, you should contact that other company directly.

WARNING: REACH 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 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 REACH is unable to perform within a

medically appropriate timeframe due to a mechanical or maintenance problem or being called on another flight.

Initial or sign here________________

COMPLAINTS: For complaints regarding REACH, first attempt to call the plan at 1 800 793 0010. If REACH 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: REACH 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).

Date:

month

/ /

day year

Check or money order made payable to:

AirMedCare Network PO Box 948 West Plains, MO 65775

1-Year Membership $35 Household

GET CODE TRACK CODE PLAN CODE

12952 7419

Membership Terms and Conditions Membership Application - Garberville Redway Area Chamber of Commerce

1 of 1

Page 1 of 3

Initial_________

Organization:

Address:

Contact:

Phone: 707-923-2613 Fax: 707-923-4789

Email: chamber@garberville.org

County: Humboldt

Membership Sales Manager/ Base: Jennifer Hart – Cal-Ore Life Flight

Participants:

1. The Organization is partnering with AirMedCare Network participating providers, an alliance of four affiliated

air ambulance providers *(each a “Company”) to offer the discounted membership fees shown below to

individuals (Participants) who are affiliated with the Organization so they can be members of the AirMedCare

Network participating provider membership programs as provided in this Agreement. The Organization

represents that it has at least 150 potential Participants. The Organization will either (1) provide a current list

of potential Participants for direct marketing and verification or (2) facilitate marketing efforts to potential

Participants and verify the affiliation status of a Participant when a completed membership application is

received.

2. A Participant must be actively affiliated with the Organization (as a member or similar relationship) when the

membership fee is paid by such Participant.

Fees and Payment:

1. The annual membership fee at a $10.00 discount to be paid by the Participants who decide to

complete a membership application

 Discounts also available on 3, 5 & 10 year memberships where available

2. If this Agreement is not renewed by the Organization, then Participants may renew their

memberships at standard rates.

General Provisions:

1. Participant memberships will be effective upon AirMedCare Network’s receipt of (a) this Agreement signed

by the Organization, (b) payment as provided above and (c) membership applications completed by the

Participants. Memberships will automatically expire without notice (i) after one year for annual payment

plans, and (ii) after one month for monthly payment plans; however, a 60 day grace period will apply if a

membership renewal payment is received within such grace period. No refunds.

2. AirMedCare Network agrees that Participant Lists and membership applications (a) will be used by

AirMedCare Network only for the purpose of delivering AirMedCare Network services, (b) will be treated like

any other AirMedCare Network confidential information and (c) will not be used, sold or shared with any third

party inconsistent with this provision.

3. This Agreement will automatically renew on its anniversary date (annually or monthly, as applicable), if (a)

no termination notice has been sent by either party and (b) payment for the renewal period is received by

AirMedCare Network before expiration of the grace period. Either party may terminate this Agreement at

any time and for any reason with 30 days prior written notice to the other party, but termination will not affect

issued memberships.

Plan Code:

*See Important Notices on Page 3 Prior to Purchase

7419

AirMedCare Network Affinity Group Membership Discount

For Garberville Redway Area Chamber of Commerce

Garberville Redway Area Chamber of Commerce

PO Box 445

Garberville, CA 95442

Cinnamon Paula

Page 2 of 3

Initial_________

Terms and Conditions

AirMedCare Network is an alliance of affiliated air ambulance providers* (each a “Company”). An

AirMedCare Network membership automatically enrolls you as a member in each Company’s

membership program. Membership ensures the patient will have no out-of-pocket flight expenses if

flown by a Company by providing prepaid protection against a Company’s air ambulance costs that

are not covered by a member’s insurance or other benefits or third party responsibility, subject to the

following terms and conditions:

1. Patient transport will be to the closest appropriate medical facility for medical conditions that are deemed by

AMCN Provider attending medical professionals to be life- or limb-threatening, or that could lead to permanent

disability, and which require emergency air ambulance transport. A patient’s medical condition, not

membership status, will dictate whether or not air transportation is appropriate and required. Under all

circumstances, an AMCN Provider retains the sole right and responsibility to determine whether or not a

patient is flown.

2. AMCN Provider air ambulance services may not be available when requested due to factors beyond its

control, such as use of the appropriate aircraft by another patient or other circumstances governed by

operational requirements or restrictions including, but not limited to, equipment manufacturer limitations,

governmental regulations, maintenance requirements, patient condition, age or size, or weather conditions.

FAA restrictions prohibit most AMCN Provider aircraft from flying in inclement weather conditions. The primary

determinant of whether to accept a flight is always the safety of the patient and medical flight crews. Emergent

ground ambulance transport of a member by an AMCN Provider will be covered under the same terms and

conditions.

3. Members who have insurance or other benefits, or third party responsibility claims, that cover the cost of

ambulance services are financially liable for the cost of AMCN Provider services up to the limit of any such

available coverage. In return for payment of the membership fee, the AMCN Provider will consider its air

ambulance costs that are not covered by any insurance, benefits or third party responsibility available to the

member to have been fully prepaid. The AMCN Provider reserves the right to bill directly any appropriate

insurance, benefits provider or third party for services rendered, and members authorize their insurers,

benefits providers and responsible third parties to pay any covered amounts directly to the AMCN Provider.

Members agree to remit to the AMCN Provider any payment received from insurance or benefit providers or

any third party for air medical services provided by the AMCN Provider, not to exceed regular charges. Neither

the Company nor AirMedCare Network is an insurance company. Membership is not an insurance policy and

cannot be considered as a secondary insurance coverage or a supplement to any insurance coverage.

Neither the Company nor AirMedCare Network will be responsible for payment for services provided

by another ambulance service.

4. Membership starts 15 days after the Company receives a complete application with full payment; however, the

waiting period will be waived for unforeseen events occurring during such time. Members must be natural

persons. Memberships are non-refundable and non-transferable.

5. Some state laws prohibit Medicaid beneficiaries from being offered membership or being accepted into

membership programs. By applying, members certify to the Company that they are not Medicaid beneficiaries.

6. These terms and conditions supersede all previous terms and conditions between a member and the

Company or AirMedCare Network, including any other writings, or verbal representations, relating to the terms

and conditions of membership.

*Air Evac EMS, Inc. / EagleMed LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These

terms and conditions apply to all AirMedCare Network participating provider membership programs, regardless

of which participating provider transports you.

We cannot display this page right now.

Page 3 of 3

Initial_________

Agreed to by:

Signature

Keith Hovey

Printed Name

Vice President

Title

Membership

Organization Name Division

Date

BEFORE YOU PURCHASE: If you are currently enrolled in a health maintenance organization (HMO) or other

health insurance, the benefits provided by REACH 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: REACH 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 REACH is unable to perform within a medically

appropriate timeframe due to a mechanical or maintenance problem or being on another call.

Initial or sign here______________________

COMPLAINTS: For complaints regarding REACH, first attempt to call the plan at 1-800-793-0010. If REACH 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: REACH 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.).

We cannot display this page right now.

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