Application for Membership

Welcome, Columbia International University



  
  

  
  

  
  

  

Your Information







Great news: This person qualifies for the CHM SeniorShare™ as a result of being 65 years or older. Learn more about the CHM SeniorShare™ program and all of the advantages here.




  


Street address, PO Box, etc. (required)

Apartment, suite, unit, building, floor, etc. (if applicable)





  


Spouse Information







Great news: This person qualifies for the CHM SeniorShare™ monthly gift reduction as a result of being 65 years or older. This advantage will be reflected on each billing cycle for which the participant qualifies. Learn more about the CHM SeniorShare™ advantage here.




  

Dependent(s) Information












Previous Conditions

Please click the button below to add conditions for which you have experienced signs, symptoms, or treatment within the past five years. Your membership in Christian Healthcare Ministries will not be denied based on your pre-existing conditions. For more information about pre-existing conditions, please see the CHM Guidelines, our FAQ's or call 833-JOINCHM.


How Did You Hear About CHM

By clicking submit below, you consent to allow Christian Healthcare Ministries to store and process the personal information submitted above to provide you the content requested. Your information is protected via the security processes described in our Privacy Policy.

Christian Healthcare Ministries is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you based on your preference indicated above/below. You may unsubscribe to these communications at any time. For more information, please review our Privacy Policy.


Checklist of Understanding

Thank you for becoming a part of Christian Healthcare Ministries (CHM). Your participation is a testament to the love Christians have for each other. Many U.S. states legally require completion of the document below in order for CHM to share your medical bills. It’s important that you fully understand that Christian Healthcare Ministries is a group of Christians who voluntarily assist each other with medical costs in accordance with the CHM Guidelines. CHM is a health cost sharing ministry, not insurance, and carries out the command of Galatians 6:2 by meeting one another’s medical costs.

Please read and check each of the following:

Select All

    • …a ministry available to share (pay) members’ healthcare costs while upholding Christian beliefs
    • …described in the national healthcare law as an acceptable option to meet the law’s individual mandate for health cost coverage
    • …not insurance, not approved or endorsed by the Department of Insurance in my state, and that medical incidents or losses are not protected by the state guaranty fund.
    • …to keep on file information concerning my participation or my family’s participation
    • …to receive medical bills and prepare them for consideration for sharing through the audited Member Sharing Account (member-to-member for Maryland members)
    • …to share medical expenses found to be eligible under the CHM Guidelines
    • …to send me CHM’s monthly Heartfelt Magazine each month (a publication/newsletter that provides ministry updates, helpful information, CHM member testimonials, communications regarding legislation and regulations that may impact my membership, the referral program, and other important program-related information.
    • …members must be active participants in the Body of Christ according to Hebrews 10:25 and continuously meet the qualifications set forth in the CHM Guidelines, including agreement with the CHM Statement of Beliefs
    • …I have read and will continuously live according to the Statements of Beliefs or will otherwise be ineligible to participate
    • …participants desire to share the medical costs of others and have their own healthcare expenses shared in a manner based on Scripture, particularly:
      • "Carry each other's burdens, and in this way you will fulfill the law of Christ." [Galatians 6:2, NIV]
      • "Let us do good unto those who are of the household of faith." [Galatians 6:10b, KJV]
      • "…and distribution was made unto every man according to his need." [Acts 4:35b, KJV]
    • …my participation, and that of all CHM members, is voluntary
    • …all members are self-pay patients who retain full responsibility for their own healthcare costs and no guarantee is ever given to those who participate
    • …participants choose to meet each other’s healthcare costs in accordance with the CHM Guidelines, though they are not bound by a contract to do so
    • …it’s my responsibility to read the CHM Guidelines and regularly review updates to CHM’s Guidelines
    • …part of monthly contributions (for non-Maryland members) goes toward a minimal administrative expense to operate CHM programs
    • …members send money to help one another out of a desire to share one another’s burdens, and it would be an abuse of their trust and will render me ineligible for CHM membership if I use money I receive to share medical bills for any purpose other than payment of those bills
    • …I am the individual listed above, I am not completing this application on behalf of anyone besides me and my immediate family, and it is unlawful for an insurance agent or any other entity to "sell" CHM or bundle it with insurance products.



Monthly Membership Cost


This total includes the monthly contribution amount(s) as well as the CHM Plus monthly unit amount, if selected.

Fill out the below payment information to complete your first month’s contribution amount.

Please Note: your first month's payment will be charged today.