Forms for Managing Your Membership

Submit a Medical Need

Complete this form to process medical needs for all accidents and injuries

Manage Your Membership

Billing Information Form
Submit/update billing information for automatic contributions

Reimbursement Submission Form
Submit/request for reimbursement.

Maternity Form
Provide proof of pregnancy and necessary updates

Adoption Assistance Needs Processing Request
Itemize eligible adoption expenses for membership sharing

Membership Changes

Membership Update Form
Submit any new information or changes to your membership

The following must be completed online.

Add/Remove Dependents
Please login in to your Member Portal by clicking Sign In. If you can not access the new portal, please call us at 1.888.244.3839 so we can enable it for you. This will allow you to add or remove dependents.

Cancellation Requests
Please login in to your Member Portal by clicking Sign In. If you can not access the new portal, please call us at 1.888.833.1408 so we can enable it for you.

HIPAA Release Form
Sign the release form using DocuSign. This will open a new browser window and walk you through authentication.

Requested changes must be received by the 25th of the month to allow time for processing. Approved changes go into effect on the 1st of the following month.

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.

Annual Membership Commitment

Each year, all members of the household age 18 and over must submit a Membership Commitment Form acknowledging their continued commitment to the:

  • Altrua HealthShare Membership
  • Statement of Standards
  • Acknowledgments section of the Membership Enrollment Application
  • Escrow Instructions for sharing of Member contributions

Complete Online—It’s Easy!

Primary Member Dependents (18+)

Download PDFs to send via email, fax or mail:

Membership Commitment Form
For Primary Member and Household

Membership Commitment Form — Dependents
For Dependents Age 18 and Older

Tax Returns

Members are eligible for exemption from the federal “tax” imposed on individuals who don’t have health insurance.
Complete the IRS Form 8965 and attach when you file your federal income tax return.

DOWNLOAD IRS 8965 FORM

Basic Instructions
  • There is no need to fill out Part I unless you already completed a different form using your state’s exchange, and obtained a certificate number. In that case, follow the instructions provided for Form 8965. You do not need to use your state’s exchange to be exempt. You need only to use Form 8965.
  • In Part II check “No”.
  • In Part III column c, “Exemption Type,” write “D” to indicate you are a member of a health care sharing ministry. If you were a member for the entire year, place an X in column d. If you were a member for only part of the year, use the additional columns to indicate the months of membership. You are considered a member for any month in which you were a member for at least one day.
IRS Instructions

If you need more details about the IRS 8965 Form, you can view the IRS instructions.

IRS 8965 Instructions