Sign Up For MemberCare

MemberCare Sign Up

$38.00

Signing up for MemberCare online is easy!  See bottom of this page for program details.

*Note that you MUST complete the checkout process and enter payment details for this application to be submitted.

MemberCare Application

  • Dependents

    LIST FULL NAME OF EACH LEGAL DEPENDENT, BIRTH DATE AND RELATIONSHIP TO YOU WHO LIVE AT THE ABOVE ADDRESS AND WILL BE INCLUDED ON THIS MEMBERSHIP (every legal dependent living with you is covered.)
  • To add another dependent, click the plus sign (+) at the end of the row.
    NameDOBSS#Relationship 
    Add a new row
  • Insurance Information

  • ProviderPolicy/Contract #Group# 
  • ProviderPolicy/Contract #Group# 
  • ProviderPolicy/Contract #Group# 
  • ProviderPolicy/Contract #Group# 
  • Sign & Submit

  • Type your name in the box following the /s/ to signify your legal signature on this application form.
  • Applicant's spouse, type your name in the box following the /s/ to signify your legal signature on this application form.
  • This field is for validation purposes and should be left unchanged.

Product Description

MemberCare® from LifeCare Ambulance Service is a simple, affordable way to protect you and your family in the event of an emergency.

MemberCare® :

  • costs only $38 per year and covers you and your immediate family members—spouse and children—who are legal dependents.
  • covers LifeCare Ambulance ground services to or from area hospitals within our service area including: Greater Battle Creek, Southern Barry County, Bellevue Branch County, St. Joseph County, Central Cass County, and Northeast Kalamazoo County. See the most current service area map here.

When you join MemberCare®, your membership becomes effective 3 days after receipt of your payment and completed application. You will then receive a membership card in the mail.

LifeCare will bill Medicare or your insurance company for any medically necessary ambulance trips. Any co-pays or deductibles your insurer requires you to pay are covered by MemberCare®, so there is no out-of-pocket expense. If the insurance company sends you the check, simply forward the check to LifeCare Ambulance. You are not responsible for any balance remaining. Medically necessary ambulance charges that are not covered by insurance are rendered at a 20% discount from regular rates.

In addition, LifeCare offers the convenience of wheelchair van transportation at a discounted rate, where available, which is usually not covered by your insurance.

Whatever the situation, we provide fast, responsive care and safe transportation for our members when it is needed most.