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Pre-Qualification
Medical Sharing Ministry Plans

Fill out our secure pre-qualification medical sharing ministry plan form and an expert from Altruis Benefits Consulting will contact you. We will help ensure you get the right medical sharing ministry plan that fits your needs.

* Indicates required questions
Name *
First
Last
Email
Phone # *
Zip/Postal Code *
-
Country *
Please select your advisor *
Are you currently receiving an Advanced Premium Tax Credit (APTC) from the Health Insurance Marketplace (HIM) to help pay your health insurance premiums? *
Do you currently have a High Deductible Health Plan (HDHP) that allows you to use tax-free money for your health care expenses? *
Have you been diagnosed with cancer or any other critical illness in the past 5 years? *
Are you currently pregnant or taking immediate steps to become pregnant? *
Do you have any surgeries scheduled currently or have you been advised to have surgery by a medical professional? *
Are you willing to change providers (i.e. Primary Care Physician, Specialists, Hospitals) to save thousands of dollars per year in medical care premiums? *
Current Health Insurance Carrier *
Current monthly premium
Current plan level
Person 1 - Age *
Person 1 - Sex *
Person 1 - Uses Tobacco *
Person 2 - Age
Person 2 - Sex
Person 2 - Uses Tobacco
Person 3 - Age
Person 3 - Sex
Person 3 - Uses Tobacco
Person 4 - Age
Person 4 - Sex
Person 4 - Uses Tobacco
Person 5 - Age
Person 5 - Sex
Person 5 - Uses Tobacco
Person 6 - Age
Person 6 - Sex
Person 6 - Uses Tobacco
Person 7 - Age
Person 7 - Sex
Person 7 - Uses Tobacco
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