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Ambulance Membership Application

General Information

Membership Information

Membership Type


South Central EMS’s membership program is not a contract for the provision of ambulance services.  A mutual aid ambulance may respond when our ambulance(s) are assigned to other 911 calls.  This is not a solicitation for the offer or sale of an insurance product.  The terms and provisions of South Central EMS’s membership program are subject to change without prior notice.  Medicare beneficiaries may be billed for co-payments or deductibles if required by law. All memberships are subject to acceptance by South Central EMS and may be cancelled and/or revoked at the sole discretion of South Central EMS. In accordance with the “Affordable Care Act” all members must have health care/medical insurance at the time of service.  Membership will not be used in lieu of approved and appropriate affordable health care. The member acknowledges that South Central EMS will bill available third party insurance for services rendered and agrees to remit any third party insurance payments received directly by the member to South Central EMS.  South Central EMS reserves the right to submit a bill to any available payment source for all ambulance calls.  You will be responsible for paying all charges for all calls which are not medically necessary as noted in the exclusions. This membership is only available to those person(s) with an insurance carrier.  **Any/All Excess money outside of the rates noted above/below will be applied as a donation to South Central EMS. 

South Central EMS thanks you for your support and continued dedication.

Thank you for submitting. We will contact you for payment and to answer any questions.

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