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Membership Application

If you have questions about the Careflight membership application, please call the Avera Foundation office at 605-322-4759.

Please Note: We no longer print and mail membership cards. Instead you will receive a membership letter.

Avera CareFlight
Purchase or renewal an Avera CareFlight membership for you and your family for $49.

$49.00

$49.00

 

Membership Agreement

  • Family Definition: Careflight membership covers you, your spouse and unmarried dependent children under the age of 26. Any dependent age 26 or over, who is incapable of self-support because of a mental or physical disability, will need to purchase a separate Careflight membership.
  • Careflight membership covers 100 percent of the cost of emergency Careflight transports within the service area.
  • For a one-year period, I hereby apply for the Careflight membership for myself and my dependent family household members listed on this application.
  • I understand that Careflight will accept insurance payment in full, for all flights covered by Careflight membership requirements.
  • For individuals without health care coverage, the entire cost of emergency transport, having met Careflight membership requirements, will be covered under the membership plan.
  • Patients will be transported to the nearest appropriate medical facility within the Avera service region, based on medical condition.
  • Physicians and/or emergency medical personnel responding to the emergency will determine medical need for airambulance transport.
  • The effective date of the plan will be the first of the month following receipt of membership payment.
  • I hereby transfer my rights for insurance reimbursement from my insurance carrier paid directly to me to Avera for coverage of emergency flight charges.
  • Reimbursement is not to exceed standard charges for air ambulance services. I also understand that my membership investment is not tax deductible and availability of immediate service may be affected by adverse weather conditions or aircraft availability.

Careflight services provided by MRIS, LLC, Avera McKennan Hospital and University Health Center, and Med-Trans Corporation.