Membership Agreement

The Southwestern Michigan Community Ambulance Service (SMCAS) Membership Program is a family protection plan offered by Southwestern Michigan Community Ambulance Service. For just $45.00 a year, Members pay no additional out-of-pocket costs for medically necessary* ambulance transportation service they may require during the year.

I understand that the SMCAS Membership Program is not insurance and SMCAS will bill me a minimal $200 co­payment for transport services rendered if the services are not covered under insurance or if no insurance payment is received. I am responsible for payment of these co-payment amounts to SMCAS.

The SMCAS Membership Program covers those individuals residing in your household that you claim as a dependent on your Federal Income Tax Form. YOU MUST USE THE SERVICES OF SMCAS IN ORDER TO QUALIFY FOR MEMBERSHIP BENEFITS. This membership is non­refundable and non-transferable.

SMCAS Memberships are available to residents of Niles City, Buchanan City, Niles Township, Buchanan Township, Bertrand Township, Howard Township, Milton, and Pokagon Township (Sections 25-36).

Memberships will be accepted throughout the calendar year, will be effective 24 hours after receipt of payment to SMCAS, and will expire 1 year from date of enrollment.

The SMCAS Membership Program is not insurance and SMCAS will pursue claim payments from your insurer or third party agency (e.g. Medicare.Medicaid, Blue Cross/ Blue Shield, etc.). By enrolling in the SMCAS membership program you are authorizing release of any medical information necessary to process a claim, and further authorize such payment to be made directly to SMCAS. If your insurance carrier makes payments directly to you, you are responsible for making payment to SMCAS.