As a HALO-Flight Guardian Subscription Plan Member, if you or your enrolled dependents require our service, we will bill your insurances (if any). As a condition of receiving this benefit, I hereby assign (hand over) to HALO‐Flight 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.’
By enrolling in this Subscription Plan, which is not an insurance product, you authorize payment of all insurance benefits or payments to HALO‐Flight. I understand that HALO‐Flight will, whenever it deems it feasible, file claims for and directly collect the benefits payable from insurance, up to the amount of HALO‐Flight’s charges for its services. When requested by HALO‐Flight, 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 HALO‐Flight, I will promptly forward those payments to HALO‐Flight at 1843 FM 665, Corpus Christi, TX 78415. FMI: firstname.lastname@example.org
- Your Membership Agreement applies only to HALO-Flight, Inc. or our reciprocal partner Dallas CareFlite. *
- Covers dependent family members who live in the same household and are listed on the application. (Includes dependent children, custodial and non-custodial children).
- Guardian Plan Membership Cards for the primary member listed on the application along with 2 vehicle decals identifying you as a Member.
- Medicaid recipients are not eligible to pay for a HALO-Flight Guardian Subscription Plan due to state regulations. We will, however, still transport these patients.
- Payments can be made by cash, check, money order, or credit card.
- New Membership is effective 14 Days after receipt and verification of payment. There is no waiting period for renewing members.
Medically Necessary: HALO-Flight Guardian Subscription Plan benefits are restricted to medically necessary services defined as a specific need for emergent helicopter air ambulance transport within our service area. The specific need must meet the Regional Advisory Council Bypass Protocol or diagnosis from a physician that determines an alternative form of transportation would be medically inappropriate regarding the patient condition. It is NOT for the convenience of a Provider, Physician, or Patient. HALO-Flight has the right to deny any request that is inappropriate based upon medical necessity or suspected Membership abuse. If abuse is found to exist, HALO-Flight reserves the right to terminate Membership.
*In the event that any member of the HALO-Flight Guardian Subscription Plan requires service from our reciprocal partner, they will be subject to their terms of the agreement. San Antonio AirLIFE dropped reciprocal affiliation in October 2015.