Member Form Links

Are you looking for quick links to member forms?

Some member forms are available online for electronic submission. You can find them here:

https://www.impacthealthsharing.com//forms

Or, here are links to other Member Forms. 

Application Add-On Family Members

Add On Form

Authorization to Release Health Information

HIPAA Release Form

BMI Verification

BMI Verification Form

Denial of Service Intake Form

Denial of Service Intake Form

Medical Expense Out of Country Reimbursement

Out of Country Medical Expense Form

Bill Submission Tool (Under the "My Medical Bills" tab of your Member Center)

Member Center

Permissions

Permissions Form

Transition to Senior Membership

Request for Roll-Off to Senior Membership

Pre Notification

Online Pre-Notification Form

Maternity Guide

Impact Maternity Guide