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2024 Membership Information

Why become a Member of Fox Township Ambulance? If you are a member and require the services of the ambulance, we will accept the amount paid by your insurance as payment in full and you will not incur any out-of-pocket expenses. If you are not a member, you will be billed for the balance not paid by insurance. 

 

Individual memberships cover people 18 years of age and over who are NOT considered as a dependent of the subscriber. That is, someone who lives in a different household or does NOT rely on the subscriber for financial support. 

Family memberships include the subscriber, their spouse/partner, children under the age of 18, full-­time college students, and handicapped family members residing in the household.

 

You will need to complete and submit payment for each membership subscription separately. Online membership subscription rates include a fee for online processing that is being charged to Fox Township Ambulance.

Membership subscriptions must be received by May 31, 2024 to be fully covered for the year.  Memberships may be submitted after May 31st, but coverage will not take effect until 1 month after your payment is received.   

Fox Township Ambulance reserves the right to bill members for repeated calls in which services are rendered but the patient refuses transport to a hospital.  These calls cannot be billed to insurance yet pose an expense to the ambulance service.  Beginning with the third such occurrence, Fox Township Ambulance will invoice the patient $200 for each incident, whether the individual is a member or  not.  

With your support, Fox Township Ambulance can continue to deliver Emergency Medical Services to our community!

Thank You!

2024 Membership
Type of Membeship (choose one)

Enter the names of the individuals residing at the above address covered by this membership:

I authorize that payment of Medicare Benefits or other insurance benefits be made on my behalf to Fox Twp. Ambulance for any ambulance services provided to me by Fox Twp. Ambulance. I authorize any holder to release to Fox Twp. Ambulance any medical information or documentation needed to determine these benefits payable for any services provided to me by Fox Twp Ambulance now or in the future.

Thanks for becoming a member and supporting Fox Township Ambulance!

Membership valid 5/1/2024 thru 5/1/2025

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