Ka Wai Ola - Office of Hawaiian Affairs, Volume 26, Number 10, 1 October 2009 — Page 2 Advertisements Column 1 [ADVERTISEMENT]

HawaikAn- Ambulance/Hawaii Life FlipHlembership Pi:ogram

loved one neeāeā an " air amhulanee? ^ l. Sl L I i \ T | %%% %. This EurocopterEC-135is one ofafleet ofsix rotor-wing and fixed-wing aircraft based in Kona, I j l" Kamuela, Kakului and Lihue; the newest and largest fleet ofmedical aircraft serving Hawaii. |./~ - ^ ' . r '"WkW — , ^ !- ' I Hawaii Air Ambulance/Hawaii Life Flight I ^ 1 Providing 24/7 air amhulanee service to the people ofHawaii wiih bases in Hilo. Kamuela. Kona. Kauai and Maui!

Hawaii Air Ambulance/Hawaii Life Flight offers exclusive medical air transport membership service that waives the members' insurance deductible and eopayment when we provide emergency air transportation between the Islands.

Our Membership saves thousands of dollars! For more information, eall (808) 833-2270. :turn application with payment . . . . ^m . . . ^m

Who are Ilawaii Air Amhulanee/ Hawaii Life Flight? Hawaii Air Ambulance/Hawaii Life Flight are the premier emergency air medical services in Hawaii whieh transport people in immediate emergency medical need from one island to another. We are staffed with professional pilots, flight nurses and flight paramedics, and have been serving Hawaii since 1979.

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"Hawaii Air Amhulanee saved our daughter's life. Mahalo!" - Timothy and Mary Catiel n g d 0 tted line and r e

How mueh would an air amhulanee transport cost, if I was not a member? It could be over $10,000. Why would I need transportation on an air ambulance? If you or a family member suffered an accident or serious medical probleml and needed to be transferred to a medical facility on another island, We would provide transport! What does membership provide me and/or my family? Membership waives the patientis deductible and co-payment when we provide qualified air medical services. How soon will my membership become active? Your membership becomes active on the date your application is signed and received by HAA/HLE Payment must follow within 30 days. Do you accept members without health insurance? No, we do not. How do I become a member? Simply Lill out the form and submit with the appropriate payment. 1 Services must be within our Scope ofCare. Transports ofsome high risk OB patients and neonates do not qualify. I

Hawaii Air Ambulance / Hawaii Life Flight Membership Program ■ PLEASE PRINT Birthdate Primary's Full Name: Month: Day: Year: | Last First Middle Mailing Address: * Number and Street or P.O. Box Number City Zip Code Telephone Number: Alternative Telephone Number: Current Health Insurance Provider: _ Member Immediate Family Memb ers (to age 18 unless full time student to 23) InSUrance B irthdate Payment Options Relationship Names Provider Month Day Year □ VISA □ MASTERCARD □ AM EX (Make eheek to HAA/HLF) □ check/M O (Mail with applieahon) Credit Card Account # Exp. Date Name as it appears on card (please print) ■ Signature of card holder ■

Senior rates apply to those 65 vears of age or older. SENIOR YEARLY RATES (eheek box) □ Single $49 (per year) □ 1 year $89/family (1 senior, 1 non-senior) □ $79 (2 seniors) □ 2 years $159/family (1 senior, 1 non-senior) □ $139 (2 seniors) □ 3 years $229/family (1 senior, 1 non-senior) □ $199 (2 seniors)

J il | For rate questions, please eall: 808-833-2270 RE GULAR YEARLY RATES (eheek box) Additional Dependents □ Single $59 (per year) n/a □ 1 vear $99/family (2-4 family members) $20 - □ 2 vears $179/family (2-4 family members) $40 □ 3 vears $259/family (2-4 family members) $60 ■

Conditions ofMembership NOTE: We do NOT acctl,t aPPMtan,s ™«hout heahh insurance. | I understand this membership is a sen'ice agreement with Hawaii Air Amhulanee/Hawaii Life Flight (HAA/HLF) and this member services brochure fully explains the air amhulanee ser\'ices provided by HAA/HLF. That all _ sen'ices covered by this membership must be arranged through HAA/HLF and must be within HAA/HLF scope of care, and the services provided under this membership constitutes all sen'ices available under this agreement. I I understand the medical necessity of all flights will be determined by certiflcation of an attending physician and HAA/HLF medical directors. I understand that HAA/HLF cannot be held liahle should another carrier be chosen to provide the transport for any reason whatsoever. That the member's entire co-payment and deductible will be "waived" afler all insurance providers have made appropriate payments. That any insurance payment made by an insurance provider and sent to the member must be submitted to HAA/HLF. Membership fees are due within thirty days (30) of this application date. Conditions & prices are subject to change. I hereby authorize the release of I any and all medical information necessary to determine the suitability for air transportation.

S ignature : Mail Application and Payment to: Hawaii Air Ambuiance/Hawaii Life Flight P.O. Box 30242 Honolulu, HI 96820

I Date: I For more information, eall 808-833-2270, go to hiairamb.com or email ■ customerseiwice@hiairamb.com R/5 ® .......