CEMS Medical Transportation is a leader in emergency and non-emergency services in the West Michigan area. We currently partner with 11 municipalities in Berrien and Van Buren counties and provide complete 24/7 9-1-1 emergency services

Join today and have the assurance that your loved ones are protected!

Membership benefits include

• Coverage of out-of-pocket costs for all “medically necessary” ambulance service for the membership year as defined below. Membership fees are tax deductible and make a great gift.

• Special rates for mobility device (wheelchair) Care-a-Van transportation services.
www.mycaravan.com.

• Safe, timely, and comfortable transportation in your time of need in one of our “mobile emergency rooms” ambulances. No hassle billing. CEMS will directly bill your insurer or third party on your behalf.

• With your paid membership you will receive: Two CEMS Plus One wallet size membership cards and CEMS Medical Transport refrigerator magnet containing contact phone numbers.

• CEMS Plus One members can visit www.cemsmedical.com for more company information, up to date information about our membership program, and other relevant CEMS Medical Transport information.

Facts about your membership

• *CEMS Medical Transport serves the primary 911 areas of: Arlington Township, Bainbridge Township, Bangor Township, Bloomingdale Township, City of Bangor, City of Coloma, Coloma Township, Columbia Township, City of Gobles, Village of Grand Junction, Hagar Township, Village of Kendal, PineGrove Township, and Village of Riverside.

• A member is not charged the amount not covered by insurance for “medically necessary” ambulance service.

• A member is defined by the primary member and his/her listed dependents on the most recent Federal Income Tax return. Your membership fee is tax deductible.

• Your membership service is provided by CEMS, a locally owned non-profit provider with more than 40 years of experience of providing emergency and non emergency medical transportation services.

Membership agreement

I understand that I must use the services of CEMS Medical Transport in order to be eligible for benefits provided by the CEMS Plus One membership. I understand that the membership fee provides me and my qualified family member’s emergency and non-emergency ambulance service.

I authorize CEMS Medical Transport to bill my primary and secondary insurance carriers, government agency, or third-party payor for any customary charges associated with this service. I request that payment of authorized insurance benefits be made on my behalf to CEMS Medical Transport for any ambulance services provided.

I authorize any holder or medical information or documentation about me to release to any insurance company, government or third party agency, as well as CEMS Medical Transport, any information or documentation needed to determine these benefits, or benefits payable for related services provided to me by CEMS Medical Transport now or in the future.

CEMS Medical Transport agrees to accept such payment as payment in full for those eligible benefits. I further understand that all services which are determined to be not medically necessary, not covered by my insurance, or other than to or from a hospital are rendered at a membership discount rate of 20%. I also understand that emergency calls have first priority, and the need for medical transportation will be determined by the medical staff of CEMS Medical Transport, and that routine medical transfers require physician authorization.

I understand that this membership is nonrefundable and nontransferable. (This membership takes effect two days after CEMS Medical Transport’s business office receives my completed and signed membership application and my annual membership fee.)

This membership contract remains in effect through April 2008.

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