Covenant HealthShare Program Disclosures

**THIS IS NOT A CONTRACT OR AN INSURANCE PRODUCT**

INTRODUCTION

This is a voluntary program offered by Covenant HealthShare, Inc. (Covenant), a 501(c)(3)* non-profit health care sharing ministry (HCSM). A HCSM is a group of individuals who share a common set of ethical or religious beliefs and voluntarily choose to share in the payment of their medical expenses in accordance with those beliefs, without regard to the state in which a member resides or is employed. Membership cannot be transferred to anyone other than the member and his/her registered dependents (as defined in Guidelines).

Services are offered on the faith-based traditions of mutual aid, neighborly assistance, and burden sharing. Covenant is specifically tailored for individuals who maintain a healthy lifestyle, make responsible choices regarding health and medical care and believe in helping others. As a HCSM, Covenant does not subsidize self-destructive behaviors or lifestyles. Covenant is NOT insurance and provides no guarantee of payment for any medical costs or expenses incurred by its members.

All Covenant members are required to acknowledge the Covenant Statement of Faith and attest that they are of like mind with those beliefs.

STATEMENT OF FAITH

Because Covenant is a faith-based organization, members are required to acknowledge and agree with the ministry’s Statement of Faith to successfully join and enjoy the benefits  of membership in the  Covenant:

We believe that Jesus Christ is the Son of God and our Lord and Savior;

We believe that our personal rights and liberties originate from our Lord, Jesus Christ;

We believe the Bible to be the inspired and only infallible written Word of God;

We believe every individual has a fundamental religious right to worship God in his or her own way;

We believe it is our moral and ethical obligation to assist our fellow man when s/he is in need according to our available resources and opportunity;

We believe it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors, and habits that result in sickness or disease to ourselves or others; and

We believe it is our fundamental right of conscience to direct our own healthcare, in consultation with physicians, family, or other valued and trusted advisors.

DISCLAIMER – NO PROMISE TO PAY

Covenant is a faith-based organization and HCSM, not an insurance company, and does not offer any insurance products or policies. As such, Covenant does not assume any risk for medical expenses and makes no promise to pay. Covenant offers voluntary participation in its HCSM programs, which are not governed by insurance laws.

Covenant does not provide a promise to pay or any guarantee of payment for medical expenses for any member. Since Covenant does not assume the member’s risks, the member is responsible for payment of his/her medical bills. Covenant does not guarantee that medical expenses will be shared by other members who utilize the health care sharing services provided by Covenant.

VOLUNTARY PARTICIPATION

Covenant members are voluntary participants in a HCSM program. Registration, membership and participation in the Covenant  program, such as the sharing of monthly member gifts, is voluntary. Initial membership registration with Covenant is not a contract. Members are free to withdraw their participation in Covenant at any time. As a part of voluntary participation in the HCSM, Covenant requests a “monthly member gift” amount to be collected from each member in order to facilitate the sharing of qualified medical expenses amongst the Covenant membership community.

GUIDELINES

Covenant manages “monthly member gifts” through established guidelines that generally define the sharing of qualified expenses between members of Covenant (the Guidelines). The Guidelines more specifically define the sharing of medical expenses between members of the Covenant program at each membership level and are outlined in the individual member guideline(s) provided at the time of registration. The Guidelines and individual member guideline(s) are not contracts and do not constitute an agreement, a promise to pay, or an obligation to share by Covenant or its members.

The Guidelines are intended to ensure that every member has paid his/her own medical expenses as they are financially able before requesting that other members share in the cost of remaining qualified medical expenses. The Guidelines generally define when a  member need is qualified, while individual member guide(s) detail what type of expenses may be qualified for sharing per membership level, including specific limitations, exclusions and requirements for sharing eligibility, so all members can expect a reasonable and equitable level of sharing. The amounts of medical needs will be published monthly in a newsletter to members.

Covenant programs may exclude or have sharing limitations for conditions existing prior to membership. Members are required to fully disclose conditions existing prior to membership as part of their registration with Covenant. Covenant reserves the right, on behalf the members, to exclude sharing eligibility for any condition existing prior to membership, whether disclosed at the time of registration or discovered after the effective date of membership. Furthermore, a member is not eligible for sharing when a member (i) receives care within the first sixty (60) days following the effective date of their membership and cancels their membership within thirty (30) days of receiving such medical care, (ii) cancels their membership within thirty (30) days of receiving medical care, except within the last ninety (90) days of their membership term, or (iii) receives elective surgery within the first sixty (60) days of becoming a member, except in the case of an accident.

Covenant reserves the right to make updates to the Guidelines and member guides at any time on behalf of its HCSM program members. The Guidelines and individual member guides in effect at the time of service will supersede all previous versions of the Guidelines and individual member guides. Members will be notified of updates to the Guidelines and individual member guides by Covenant.

MEDICAL NEEDS AND USE OF FUNDS

After receiving a sharing request for qualified medical need from a member or a member’s provider, Covenant will assign the expense(s) for sharing between the members, less the amount of the  requesting member’s required personal responsibility, called the Personal Responsibility Amount Yearly (PRAY).

Voluntary “monthly membership gifts” are received each month from each Covenant member. Up to thirty percent (30%) of membership contributions may be applied towards Covenant program administration, charitable causes, or general overhead costs, not including marketing costs to grow the membership. Administrative costs are subject to change by Covenant and may be applied towards other charitable causes or general overhead costs.

HCSM TAX MATTERS

Members should always consult with a tax professional to determine whether participation in a  HCSM, including Covenant, may have tax implications.

SPECIFIC PROGRAM DISCLOSURES

Please refer to Covenant membership guidelines for specific details about contributions, expenses qualified for sharing, limitations, exclusions, and other requirements for sharing eligibility under the specific membership level of the Covenant HCSM program: (Link to member guidelines)

AUTHORIZATIONS

• I authorize Covenant to collect the monthly member gift amount from me as a recurring monthly transaction.
• I authorize my initial monthly member gift amount to be processed immediately upon completion of my registration with Covenant.
• I authorize Covenant and its affiliates to contact providers to request the release of medical records on my behalf as a member of Covenant.

ACKNOWLEDGMENT

• I understand that the registration fee and charitable contribution will not be refunded if all individuals on my registration form fail to attest to the Covenant Statement of Faith.
• I understand that only the registration fee will be refunded if I withdraw my registration prior to the effective date of my membership.
• I understand that the Covenant registration fee and charitable contribution will not be refunded to me if, in the course of registering, I fail to respond to written or verbal inquiries from Covenant for more than sixty (60) days.
• I understand that by submitting my registration information to Covenant, I am voluntarily requesting participation in a Covenant HCSM membership level.
• I affirm that the name and personal information provided on this form are true and correct.
• I understand that Covenant and its affiliates have the authority to request my medical records to facilitate the sharing of my medical expenses.
• I affirm that I understand and accept the disclosures presented in this document.

STATE LEGAL NOTICES

LEGAL NOTICES

The following legal notices are required by state law and are intended to notify individuals that HCSM  programs are not insurance and that Covenant does not provide any guarantee or promise of payment for any medical costs or expenses incurred by its members.

GENERAL LEGAL NOTICE

Covenant facilitates the sharing of medical expenses but is not an insurance company, and neither its guidelines nor program of operation is an insurance policy. Sharing is available among members for all qualified medical expenses; however, Covenant does not guarantee or promise that your medical bills will be paid or assigned to other members for payment. Whether any other member chooses to contribute, in whole or in part, to the payment of your medical bills is completely voluntary on the part of that member. As such, membership in Covenant should never be considered as a substitute for an insurance policy. Whether you or your provider(s) receive any payments for medical expenses and whether or not Covenant continues to operate, you are always liable for any unpaid medical bills. This HCSM is not regulated by state departments of insurance. You should review Covenant’s guidelines carefully to be sure you understand any limitations that may affect your personal medical and financial needs.

STATE SPECIFIC NOTICES

Alabama Code 22-6A-2, 22-6A-3

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Alaska Statute 21.03.021(k)

Notice: The organization coordinating the sharing of medical expenses is not an insurance company, and neither its guidelines nor plan of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. Participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive a payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Arizona Statute 20-122

Notice: The organization facilitating the sharing of medical expenses is not an insurance company and the ministry’s guidelines and program of operation are not an insurance policy. Whether anyone chooses to assist you with your medical bills will be completely voluntary because participants are not compelled by law to contribute toward your medical bills. Therefore, participation in the ministry or a subscription to any of its documents should not be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this ministry continues to operate, you are always personally responsible for the payment of your own medical bills.

Arkansas Code 23-60-104(2), 23-76-103(c)(1)

Notice: The organization facilitating the sharing of medical expenses is not an insurance company and neither its guidelines nor program of operation is an insurance policy. If anyone chooses to assist you with your medical bills, it will be totally voluntary because participants are not compelled by law to contribute toward your medical bills. Participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive a payment for medical expenses or if this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Florida Statute 624.1265

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor its plan of operation is an insurance policy. Membership is not offered through an insurance company, and the organization is not subject to the regulatory requirements or consumer protections of the Florida Insurance Code. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant is compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payments for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Georgia Code 33-1-20

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Idaho Code 41-121

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Illinois Statute 215 III. Comp. Stat. 5/4, Class 1(b)

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor program of operation constitute or create an insurance policy. Any assistance you receive with your medical bills will be totally voluntary. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Whether or not you receive any payments for medical expenses and whether or not this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Indiana Code 27-1-2.1-1, 27-1-2.1-2

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor its program of operation is an insurance policy. Any assistance you receive with your medical bills will be totally voluntary. Neither the organization nor any other participant can be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Whether or not you receive any payments for medical expenses and whether or not this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Kentucky Statute 304.1-120(7)

NOTICE: UNDER KENTUCKY LAW, THE RELIGIOUS ORGANIZATION FACILITATING THE SHARING OF MEDICAL EXPENSES IS NOT AN INSURANCE COMPANY, AND ITS GUIDELINES, PROGRAM OF OPERATION, OR ANY OTHER DOCUMENT OF THE RELIGIOUS ORGANIZATION DO NOT CONSTITUTE OR CREATE AN INSURANCE POLICY. PARTICIPATION IN THE RELIGIOUS ORGANIZATION OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHALL NOT BE CONSIDERED INSURANCE. ANY ASSISTANCE YOU RECEIVE WITH YOUR MEDICAL BILLS WILL BE TOTALLY VOLUNTARY. NEITHER THE ORGANIZATION NOR ANY PARTICIPANT SHALL BE COMPELLED BY LAW TO CONTRIBUTE TOWARD YOUR MEDICAL BILLS. WHETHER OR NOT YOU RECEIVE ANY PAYMENTS FOR MEDICAL EXPENSES, AND WHETHER OR NOT THIS ORGANIZATION CONTINUES TO OPERATE, YOU SHALL BE PERSONALLY RESPONSIBLE FOR THE PAYMENT OF YOUR MEDICAL BILLS.

Louisiana Statute 22:318, 22:319

Notice: The ministry facilitating the sharing of medical expenses is not an insurance company. Neither the guidelines nor the program of operation of the ministry constitutes an insurance policy. Financial assistance for the payment of medical expenses is strictly voluntary. Participation in the ministry or a subscription to any publication issued by the ministry shall not be considered as registration in any health insurance program or as a waiver of your responsibility to pay your medical expenses.

Maine Statute title 24-A, §704

Notice: The organization facilitating the sharing of medical expenses is not an insurance company and neither its guidelines nor program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. Participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Michigan Comp. Laws 550.1865, 550.1867

Notice: The eligible entity that operates this health care sharing ministry, Covenant HealthShare, Inc., is not an insurance company and the financial assistance provided through the ministry is not insurance and is not provided through an insurance company. Whether any participant in the ministry chooses to assist another participant who has financial or medical needs is totally voluntary. A participant will not be compelled by law to contribute toward the financial or medical needs of another participant. This document is not a contract of insurance or a promise to pay for the financial or medical needs of a participant by the ministry. A participant who receives assistance from the ministry for his or her financial or medical needs remains personally responsible for the payment of all of his or her medical bills and other obligations incurred in meeting his or her financial or medical needs.

Mississippi Code 83-77-1

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment of medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Missouri Statute 376.1750

Notice: This publication is not an insurance company nor is it offered through an insurance company. Whether anyone chooses to assist you with your medical bills will be totally voluntary, as no other subscriber or member will be compelled to contribute toward your medical bills. As such, this publication should never be considered to be insurance. Whether you receive any payments for medical expenses and whether or not this publication continues to operate, you are always personally responsible for the payment of your own medical bills.

Nebraska Statute 44-311

IMPORTANT NOTICE: This organization is not an insurance company, and its product should never be considered insurance. If you join this organization instead of purchasing health insurance, you will be considered uninsured. By the terms of this agreement, whether anyone chooses to assist you with your medical bills as a participant of this organization will be totally voluntary, and neither the organization nor any participant can be compelled by law to contribute toward your medical bills. Regardless of whether you receive payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills. This organization is not regulated by the Nebraska Department of Insurance. You should review this organization’s guidelines carefully to be sure you understand any limitations that may affect your personal medical and financial needs.

New Hampshire Statute 126-V:1

IMPORTANT NOTICE: This organization is not an insurance company, and its product should never be considered insurance. If you join this organization instead of purchasing health insurance, you will be considered uninsured. By the terms of this agreement, whether anyone chooses to assist you with your medical bills as a participant of this organization will be totally voluntary, and neither the organization nor any participant can be compelled by law to contribute toward your medical bills. Regardless of whether you receive payment for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills. This organization is not regulated by the New Hampshire Insurance Department. You should review this organization’s guidelines carefully to be sure you understand any limitations that may affect your personal medical and financial needs.

North Carolina Statute 58-49-12

Notice: The organization facilitating the sharing of medical expenses is not an insurance company and neither its guidelines nor its program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be voluntary. No other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this organization continues to operate, you are always personally liable for the payment of your own medical bills.

South Dakota Codified Laws 58-1-3.3

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the organization or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payments for medical expenses or whether this organization continues to operate, you are always personally responsible for the payment of your own medical bills.

Texas Ins. Code 1681.001, 1681.002, and 1681.003

Notice: This health care sharing ministry facilitates the sharing of medical expenses and is not an insurance company, and neither its guidelines nor its program of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the ministry or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this ministry continues to operate, you are always personally responsible for the payment of your own medical bills. Complaints concerning this health care sharing ministry may be reported to the office of the Texas attorney general.

Virginia Code 38.2-6300, 38.2-6301

Notice: This publication is not insurance, and is not offered through an insurance company. Whether anyone chooses to assist you with your medical bills will be totally voluntary, as no other member will be compelled by law to contribute toward your medical bills. As such, this publication should never be considered to be insurance. Whether you receive any payments for medical expenses and whether or not this publication continues to operate, you are always personally responsible for the payment of your own medical bills.

Wisconsin Statute 600.01(1)(b)(9)

ATTENTION: This publication is not issued by an insurance company, nor is it offered through an insurance company. This publication does not guarantee or promise that your medical bills will be published or assigned to others for payment. Whether anyone chooses to pay your medical bills is entirely voluntary. This publication should never be considered a substitute for an insurance policy. Whether or not you receive any payments for medical expenses, and whether or not this publication continues to operate, you are responsible for the payment of your own medical bills.

Wyoming Statute 26-1-104

Notice: The organization facilitating the sharing of medical expenses is not an insurance company, and neither its guidelines nor plan of operation is an insurance policy. Any assistance with your medical bills is completely voluntary. No other participant is compelled by law or otherwise to contribute toward your medical bills. Participation in the organization or a subscription to any of its documents shall not be considered to be health insurance and is not subject to the regulatory requirements or consumer protections of the Wyoming insurance code. You are personally responsible for payment of your medical bills regardless of any financial sharing you may receive from the organization for medical expenses. You are also responsible for payment of your medical bills if the organization ceases to exist or ceases to facilitate the sharing of medical expenses.

Covenant HealthShare,  Inc. is NOT insurance. Covenant HealthShare, Inc. is not restricted from operating in any of the 50 United States, U.S. territories, or any foreign country, and has no legal barriers of which we are aware; however, we do not market membership in CO, MA, MD, PA, and WA. Limitation subject to change without prior notice.

© Covenant HealthShare, Inc. All rights reserved.