Today’s medical care is of a higher quality and saves more lives than ever before. But it is also increasingly expensive. Metro-Area Ambulance Service (MAAS) hopes you will never hesitate to call 911 because you are worried about an ambulance bill. That’s why MAAS offers affordable, easy-to-apply-for family memberships.

MAAS is committed to serving you and your family. MAAS has only one mission: to be there with top-quality medical help when you and your family most need it.

The MetroCare Membership program is an official program of MAAS which offsets the cost of emergency medical responses. Without the Membership Program, one emergency call can cost you hundreds of dollars.

Annual membership provides for the prepayment of co-payments and deductibles for medically necessary ambulance services for which the patient has financial responsibility. MetroCare Membership also provides for a reduced fee for non-emergency transportation that is not covered by insurance. MetroCare Membership is not an insurance policy or supplement.

DESCRIPTION OF MEMBERSHIP AND FEE
As a member of the MetroCare Membership Program you will not be charged for any medically necessary emergency or non-emergency care and ambulance transportation to and from any hospital within the 15 mile radius boundary of Bismarck-Mandan during the term of this agreement. The annual fee for membership is $50.00 per household. Household is defined as husband and wife and children under the age of 21.

EFFECTIVE DATE
Your annual membership will run from 10 days after receipt of your application through the start date of the following year. Coverage is effective 10 days after receipt of your signed application, membership fee, and acceptance by Metro-Area Ambulance Service, Inc. You will receive a membership card reflecting your membership and expiration date.

WHAT SERVICES ARE PROVIDED?
Emergency and Non-emergency service is as follows: Medically necessary care and transportation is provided from any location within a 15 mile radius of Bismarck-Mandan where there is a need for ambulance transportation and where the use of alternative forms of transportation (e.g. wheelchair transports, private car, taxi) would be medically inappropriate given your medical condition.
Metro-Area Ambulance Service, Inc. reserves the right to make final determination of medical necessity. You will be responsible for the cost of any non-medically necessary transports as determined by Metro, your insurance carrier or third-party payer.

ELIGIBILITY/PERSONS COVERED
The services are provided to you, your spouse, your dependent children under the age of 21 years. These individuals must be regularly living in your residence and be listed on your membership application.

YOU MUST HAVE INSURANCE TO PARTICIPATE IN METROCARE
This agreement is between Metro-Area Ambulance Service, Inc. and you, it is not an insurance agreement or intended to be a substitute for insurance. In the event that you have insurance or other third-party coverage which pays for any services provided under this agreement, you assign the right to such payments of benefits to Metro and authorize Metro to collect such payments or benefits directly.
To help process claims, you authorize the release of any medical information necessary to process the claim. If your insurance or third-party carrier pays you directly for services provided under this agreement, you agree to forward such payments to Metro-Area Ambulance Service, Inc.

AUTHORIZATION TO PAY INSURANCE BENEFITS
I hereby authorize payment directly to the Metro-Area Ambulance Service of the ambulance benefits otherwise payable to me but not to exceed the ambulance regular charges for the period of service. I understand I am responsible to the ambulance service for charges deemed not medically necessary. I request that payment of authorized Medicare and/or insurance benefits be made either to me or on my behalf to Metro-Area Ambulance for any services furnished me by that supplier. I authorize any holder of hospital or medical information about me to be released to Metro-Area Ambulance Service, Inc., the Health Care Financing Administration and/or my insurance carrier, and their agents, any other information needed to determine these benefits or the benefits payable for related services. I permit a copy of this authorization to be used in place of the original. I understand this authorization may be used by the supplier for all services in the future until such time as I revoke this authorization in writing.

RENEWAL/TERMINATION
Your membership is not automatically renewed and is at the discretion of Metro-Area Ambulance Service, Inc. Those members who are eligible for renewal will receive information regarding renewal prior to expiration. You may voluntarily terminate this agreement at any time, but there will be no refund of your annual fee or any part thereof.

MEMBER INFORMATION
You agree to notify Metro of any change of relevant information about you during the term of your membership, including change of address, additions or deletions of covered persons, and insurance coverage. This agreement is non-transferable.

METRO-AREA AMBULANCE SERVICE
Box 595, Mandan, North Dakota 58554
Headquarters - 2940 N 19th Street, Bismarck
Bismarck Substation - 1139 Memorial Highway
Mandan Substation - 115 15th Street NE
Administration: 701-255-0812
Fax: 701-255-7247
Local-Long Distance Transfers: 1-800-441-1310
Metro Care Membership Program: 701-255-7149