I understand that the Altrua HealthShare membership is not insurance but is a voluntary medical expense sharing program, and that there are no representations, promises, or guarantees that my medical needs will be shared. I also understand that the contributions for medical needs do not come from an insurance company, but from the membership according to the membership guidelines and Escrow Instructions.

I understand that acceptance into the membership is not an entitlement but a privilege based, in part, on the medical history information I provide in this application. I also understand that any medical condition that is inquired about but not disclosed on this application, whether meeting the definition of a pre-existing condition or not, and then discovered after my membership is effective will be treated as if it had been disclosed at the time of application by applying the governing standards set forth in the Membership Eligibility Manual retroactively to my effective date of membership.

I understand that failure to uphold my commitments (shown under COMMITMENTS on this page) and to abide by the Statement of Standards may result in my membership becoming inactive and ineligibility of my medical needs. I understand that the guidelines in effect on the date of medical services supersede any spoken or verbal communication and all previous versions of the guidelines. I also understand that with notice to the general membership the guidelines may change at any time based on the preferences of the membership, and decisions, recommendations and approval of the Board of Trustees.

I understand that the guidelines are not a contract and do not constitute a promise or obligation to pay, but instead are for Altrua HealthShare’s reference in following the membership Escrow Instructions. I also understand that the guidelines are part of and incorporated into this Altrua HealthShare Application as if appended to it.

I understand that each child must be a dependent to participate on their parent’s membership. I also understand that eligibility for the membership for anyone, a dependent or otherwise, is based on the guidelines and that continued payment of monthly contributions does not extend an ineligible participant’s membership.

I understand that monthly contributions amounts are based on operating and medical needs and the total number of members and that monthly contributions are figured on a periodic basis as needed and are subject to change at any time. I also understand that the payment of my monthly contributions is voluntary and that I am not obligated in any way to send any money. I also understand that if I receive monthly contributions for my medical needs, my name and address will be reported to the contributor of those monthly contributions.

I understand that the Program does not pre-authorize medical procedures or treatment and that verification of eligible medical needs occurs only after charges are incurred.