Member Resources

For Altrua HealthShare to process medical needs for all accidents and injuries, members must complete this form.

Needs Processing

To claim eligibility for exemption from the federal “tax” for not having health insurance, download this form.

IRS 8965 Form

Download General PDF Forms for existing members.

Please attach necessary documents and submit completed forms(except Maternity Self Pay) to MemberForms@AltruaHealthShare.org

Commitment Form

This form must be submitted after enrollment in the membership and on the anniversary date of the membership to ensure that information is accurate and in good standing before any eligible needs or medical claims will be shared.
Commitment Form

Filling and Signing

You may fill and sign any of our forms and email them using the free Adobe Acrobat Reader.
Please follow these instructions to add your signature before sending.