Add-On Family Form
Add-on a new family member.
MEMBER FORMS
Medical expense form - out of country
Submit medical expenses for processing that were incurred outside the United States.
Medical expense form
Submit medical expenses for processing.
Extra Impact Application
Special assistance for Impact members in need.
Health & Wholeness Credit expense form
Submit expenses for the Health & Wholeness Credit for processing.
- DPC (Direct Primary Care) memberships
- Naturopathic Medications/Supplements
- Acupuncture
- Services rendered by Naturopathic Providers
- Gym Memberships
pre-ELIGIBILITY
Providers, please request a pre-eligibility review by either calling (855) 378-6777 or completing the online form.
Get Started OnlinePre-eligibility submission is only for the following:
- Cancer Treatment
- Elective Cardiac Procedures
- Non-emergency inpatient/outpatient surgery
- Organ/Tissue Transplant Services
- Maternity
- Imaging: MRIs and Nuclear Imaging (excluding CT Scans and xrays)
Provider Outreach Request
- Available only after an appointment is scheduled.
- This form is for Provider Visits only.
- Not applicable for Senior Program
.webp?width=300&name=SR%20BLOG%20IMAGES%20(5).webp)
Pre-Eligibility vs. Provider Outreach
Which one do I need?
Pre-eligibility ensures that specific treatments are eligible for sharing before you receive them. Medical records are required for review.
Provider Outreach is for contacting your provider if they are unsure about accepting Impact Health Sharing.
PRA Change Request
Requests may be made annually within 30 days of membership date.
%20(900%20x%20900%20px)%20(950%20x%20700%20px)%20(7)-1.webp?width=300&name=blogImages%20-%20Impact%20(1200%20x%20630%20px)%20(900%20x%20900%20px)%20(950%20x%20700%20px)%20(7)-1.webp)
Request member Card
Submit a request for a new member card.
Quick Links
