Member Plus Membership

COVERED WHEN YOU NEED IT

Trusted coverage provided by your local ambulance service. Protect yourself against the unexpected.

One ambulance trip can cost $800 or more. With Member Plus, you and your whole family are covered for just $42 a year.

MEMBERSHIP BENEFITS

Member Plus membership program is provided by your local ambulance service. We operate in 14 counties across southern Michigan.

With Member Plus you can save money if you or your family ever need an ambulance in an emergency. Insured members have no out-of-pocket costs for medically necessary emergency ambulance service. Discounts are available for non-insured members.

It’s easy to sign up for Member Plus and you can join at any time.

Member Plus Coverage Area

Member Plus Benefits

No out-of-pocket costs for medically necessary emergency ambulance transports
Two non-transport ambulance services covered each membership year
Coverage available across 14 counties in southern Michigan
Great for seniors without supplemental insurance or families with high deductibles
Support your local nonprofit ambulance service

Sign Up for a Membership
Renew an Existing Membership
Purchase a Gift Membership

Signing up for Member Plus online is safe and easy. *Note: you must complete the checkout process and enter your payment details for the application to be submitted. For a printable form to send by mail click here.

Member Plus Subscriber Information
Date*
MM slash DD slash YYYY
Subscriber's Full Name*
First Last
Subscriber's Date of Birth*
MM slash DD slash YYYY
Subscriber's Address*
Address Line 1 Address Line 2 City State Zip Code
Subscriber's Phone*
Subscriber's Email*
Dependents
List full name, birth date, and relationship of each legal dependent. Dependents must be listed on your tax form to be covered by your Member Plus plan.

Dependent Information

Name	Date of Birth	Relationship to Member	Actions

There are no Dependents.

Insurance Information
Please include information for all insurance plans held by the applicant, spouse, or dependents.

Insurance Plans

Policy Holder Name	Insurance Provider	Policy/Contract #	Group #	Actions

There are no Insurance Plans.

How did you hear about Member Plus?*
Sign and Submit
Complete the steps below. Your application will not be complete until you enter payment information.
Member Plus Terms and Conditions*
Acknowledgement: Member Plus is not insurance and does not reduce the obligations of any third-party payer. The services of an ambulance service owned and operated by Emergent Health Partners must be used to be eligible for membership benefits. Emergency 9-1-1 calls have priority over non-emergency calls. Member Plus does not pay for charges associated with Fire Department assistance in a medical emergency.

Membership Coverage: Individuals covered by this membership include the applicant, spouse and legal dependents listed on the application. All dependent children/adults must be listed as dependents on the applicant’s federal income tax form and meet the dependency exemption requirements of the IRS.

Membership Fee/Assignment of Rights: By paying the membership fee, I consent to all terms and conditions of the Member Plus program. The membership fee is non-refundable, nontransferable, and not tax deductible. I assign to the ambulance service all relevant rights and benefits of all health insurance policies or plans and any other benefits or plans which provide ambulance service coverage.

Membership Period: Member Plus plans can be renewed at any time during the year. Membership is valid for 12 months from the time a renewal application and payment is received. The membership becomes effective upon receipt of your completed application and payment.

Eligibility: Member Plus users must live in the Member Plus service area as described in the application brochure.

Membership Services: The Member Plus program covers out-of-pocket cost for medically necessary ground ambulance transport for all members listed on the completed application. Any services rendered that are not covered by insurance or Member Plus are eligible for a 20% discount. Call 888-463-7587 for more information.

Non-Transport Services: Member Plus covers two (2) non-transport ambulance services per household, per membership year. Non-transport services include lift assists, paramedic assessment, and at-home treatment.

Consent to Third Party Reimbursement: Member Plus users give consent for their transporting ambulance service to file for and collect payment for ambulance services from any and all health insurance policies, plans, or benefit programs, up to the total amount charged for ambulance services.

Reimbursement for Membership Services: Member Plus users will make available all medical insurance and benefits information to the Member Plus program. Members are responsible for the remaining cost of all services not covered by Member Plus.

Cancellation of Membership: Member Plus has the right to terminate or refund membership fees at its sole discretion.
By checking this box, I affirm that I have read and agree to the terms and conditions.
Member Plus Application Signature*

Use mouse, stylus or finger
Date*
MM slash DD slash YYYY
Spouse's Signature
Date
MM slash DD slash YYYY
MemberPlus Membership - 1yr.
Price:
Donation Amount (optional)
Total
$0.00
Billing Address*
Same as Subscriber's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Phone Number*
Billing Email*
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.

If you are already a member use the form below to renew for another year. EMS Plus and Member Care members can use this form to renew their subscription.

Member Plus Subscriber Information
Date*
MM slash DD slash YYYY
Member Number*
Member's Full Name*
First Last
Member's Date of Birth*
MM slash DD slash YYYY
Member's Phone*
Member's Email*
Member's Address*
Address Line 1 Address Line 2 City State Zip Code
Family Changes
Please list any changes in your dependents.
Updated Dependent Information
Insurance Changes
If you, your spouse, or dependents have had insurance changes in the past 12 months, please provide current information.

Insurance Plans

Policy Holder Name	Insurance Provider	Policy/Contract #	Group #	Actions

There are no Insurance Plans.

MemberPlus Membership Renewal - 1yr.*
Price:
Donation Amount (optional)
Total
$0.00
Billing Email*
Billing Phone*
Billing Address*
Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

Member Plus Gift Recipient Information
Use the form below to purchase a Member Plus subscription for a loved one. For a printable form to send by mail click here.
Date*
MM slash DD slash YYYY
Member Plus Gift Recipient Name*
First Last
Member Plus Gift Recipient Phone*
Member Plus Gift Recipient Address*
Address Line 1 Address Line 2 City State Zip Code
Purchaser Information
Purchaser Name*
First Last
Purchaser Phone*
Purchaser Email*
Purchaser Address*
Address Line 1 Address Line 2 City State Zip Code
Who will handle Member Plus renewals?*
- Myself
- Gift Recipient
MemberPlus Membership Gift - 1yr.*
Price:
Donation Amount (optional)
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Name
This field is for validation purposes and should be left unchanged.

Member Plus Membership

Member Plus Coverage Area

Member Plus Benefits

Member Plus Subscriber Information

Family Changes

Insurance Changes

Member Plus Gift Recipient Information

Purchaser Information

Contact Us for More Information

Contact emergent health partners

Member Plus Membership

Member Plus Coverage Area

Member Plus Benefits

Member Plus Subscriber Information

Dependents

Insurance Information

Sign and Submit

Member Plus Subscriber Information

Family Changes

Insurance Changes

Member Plus Gift Recipient Information

Purchaser Information

Contact Us for More Information

Contact emergent health partners