All membership PDF forms are listed here.

Submitting a Need

To process medical needs for all accidents and injuries, members must complete and submit this form.

Managing Your Membership

Billing Information Form
Submit/update billing information for automatic contributions

Add/Remove Dependent (Member Portal)
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.

Maternity Form
Provide proof of pregnancy and necessary updates

Recreational Activities Share Increase Form
Increase the shared amount for recreational activities for a member

Occupational Share Increase Form
Add a sharing amount for income producing or work related injuries

Membership Commitment Form
Must be submitted by new members and annually, within 30 days of the renewal date

Membership Changes

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

Cancellation Request Form
Request that your membership be cancelled

Requested changes must be received by the 15th 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 find the IRS instructions here: IRS 8965 Instructions