Care Plan: Become a Member

Rockford Ambulance Care Plan
Membership Terms and Conditions

Your initial membership payment covers your household from the time Rockford Ambulance receives the signed contract and full payment of $39 and continues until September 30. All members must be on record with Rockford Ambulance to receive benefits.
Membership covers emergency and non-emergency stretcher ambulance and paramedic services provided within a 50 mile radius of Rockford Ambulance office located at 8450 Shaner Ave., NE Rockford, MI 49341 by Rockford Ambulance and its affiliates when medically necessary to and from the hospital, at no out-of-pocket expense during the contract period if you have insurance.
24 Hour advance scheduling is required, and physician authorization of medical necessity is required for all non- emergency services. Call 911 to request emergency service. If you do not have insurance, your membership entitles you to a discount on your total bill. You understand that you are responsible for paying the balance.
You understand that the patient is responsible for the payment of services, and that because you are a Care Plan Member, Rockford Ambulance will accept your active insurance company or medical benefit provider’s reimbursement as payment in full. You agree to cooperate with the claim submission to your medical benefit providers and to provide any correspondence regarding this claim to Rockford Ambulance if requested. You further agree to submit any insurance reimbursement you may receive for Rockford Ambulance and its affiliates directly to Rockford Ambulance. Failure to fully cooperate with Rockford Ambulance and abide by these terms will result in termination of your membership and make you responsible for any unpaid expenses.
Membership also includes reduced rates for wheelchair van and non-emergency treatments and ambulance transfer services. Call 616-884-4133 to schedule.
Membership in Rockford Ambulance Care Plan is non-transferable and non-refundable. For federal tax purposes, the membership fee is not deductible as a charitable contribution, but may be eligible for deduction as an itemized medical expense. Rockford Ambulance does not solicit from persons who receive welfare medical benefits, and membership constitutes a voluntary contribution only. This is not an application for an insurance policy. You request that payment of authorized Medicare/insurance benefits be made on your behalf to Rockford Ambulance for services provided by Rockford Ambulance. You authorize any holder of medical information about you to be released to the health care finance administration, its agents and carriers as well as Rockford Ambulance that may be necessary to determine benefits payable for services by Rockford Ambulance. You agree you will sign any HIPAA authorization required. For questions call 616-866-0724.