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
Membership Commitment Form
Must be submitted by new members and annually, within 30 days of the renewal date
Membership Commitment Form — Dependents
Must be submitted by new dependents and annually, within 30 days of the renewal date
Membership Changes
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 888-244-3839 so we can enable it for you. This will allow you to add or remove dependents.
Membership Update Form
Submit any new information or changes to your membership
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 888-244-3839 so we can enable it for you.
Link for HIPAA Release Form
Generate a HIPPA Release form by clicking Make HIPAA Form. 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.
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.
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.