Application for Membership

Welcome, General Group Additions



  
  

  
  

  
  

Your 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.


  




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 the information you provide. The information will, however, help us determine if we can assist you through one of our programs for pre-existing conditions.


Monthly Participation Cost

  


This total includes the monthly participation gift amount(s), as well as the Brother’s Keeper monthly unit amount, if selected.

Please note that beginning January 1, 2022, CHM's monthly gift amounts will be as follows: Gold at $205, per unit; Silver at $125, per unit; Bronze at $85, per unit. Brother's Keeper gift amounts will not be included with the monthly gift until January 2022.

Information on making your first gift payment, as well as setting up automatic giving, will be sent to the email address provided within 24 hours after your application has been processed.


Group Information



How Did You Hear About CHM


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 (chministries.org/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 initial each of the following:

    • …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
    • …is not insurance and therefore 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 member-to-member sharing through the audited Member Sharing Account
    • …to share medical expenses found to be eligible under the CHM Guidelines
    • …to send me CHM’s monthly Heartfelt Magazine each month (a publication that provides ministry updates, helpful information and CHM member testimonials)
    • …members must be active participants in the Body of Christ according to Hebrews 10:25 and meet the qualifications set forth in the CHM Guidelines, including agreement with the CHM Statement of Beliefs
    • …participants desire to know 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 so fulfill the law of Christ" (Galatians 6:2)
      • "Let us do good unto those who are of the household of faith" (Galatians 6:10b)
      • "…and distribution was made unto every man according to his need" (Acts 4:35b)
    • …participation in CHM by me and other CHM members is voluntary
    • …members are self-pay patients who retain full responsibility for our healthcare costs and that guarantees are not 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
    • …part of my monthly financial gift goes toward a minimal administrative expense to operate CHM programs
    • …if my medical needs are submitted to CHM for sharing, they may be shared or rejected according to the Guidelines
    • …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


Your Church Information

Information about your local church will enable CHM staff to communicate more effectively with participants and will provide an important tool to help us grow. Christian Healthcare Ministries will not share, sell, or rent this information to third parties for their marketing purposes, nor will we contact your church without your permission.











Your employment information


Check any that apply

Your spouse's employment information


Check any that apply








Please note: Christian Healthcare Ministries, Inc. (CHM), is a non-profit religious corporation organized under the laws of the State of Ohio, and is not an insurance company. No ministry operations or publications are offered through or operated by an insurance company or insurance agents. CHM does not guarantee or promise that your medical bills will be shared or assigned to others for financial gifts. Whether any CHM member chooses to share the burden of your medical bills is completely voluntary on CHM's part. As such, CHM should never be considered as a substitute for an insurance policy. Regardless of whether you receive any financial gifts for medical expenses, and regardless of whether CHM continues to operate, you are always liable for all medical expenses you incur. If your participation in CHM ends, state law may subject you to a waiting period before you are able to apply for health insurance coverage.