For Altrua HealthShare to process medical needs for all accidents and injuries, members must complete this form.
To claim eligibility for exemption from the federal “tax” for not having health insurance, download this form.
Download General PDF Forms for existing members.
- Automatic Payment Program/ACH Request Form
- Application add on (for spouses or dependent)
- Member (self-pay) Maternity Policy Form
- Recreational Activities Share Increase Form
Please attach necessary documents and submit completed forms(except Maternity Self Pay) to MemberForms@AltruaHealthShare.org
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.