Russell Dorfler

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Authorizations

  • I authorize Kingdom to collect the Individual Share Amount as a recurring monthly transaction.
  • I authorize my first Individual Share Amount to be processed immediately upon completion of my enrollment.
  • I authorize Kingdom to contact providers to obtain the release of my medical records, and the medical records of all enrollees on the application.

 

Acknowledgments

  • I affirm that the name and personal information provided on this form are true and correct.
  • I affirm that I understand and accept the disclosures presented above.
  • I understand that there are no representations, promises or guarantees that my medical expenses will be paid.
  • I also understand that any funds that I may receive for medical expenses do not come from an insurance plan, but are voluntary contributions by the members.
  • I understand that the Guidelines, program details, and Individual Share Amounts may be adjusted at any time by Kingdom.

 

Refunds

Within the first 30 days of a new member's active date, the member is entitled to a full refund, including the one-time application fee. After the first 30 days, a refund for the most recently paid period may be processed if the request is submitted within 10 days of their scheduled billing date. 

Refunds will be processed as a credit to the same card or account provided for billing.  Requests involving refunds payable by check may be delayed up to 30 business days.

States Available

AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WA, WI, WV, WY


States Not Available

MD, MA, VT
Product
$0.00 per Month for Member
$0.00 per Month for Member + 1
$0.00 per Month for Family

Health Care Sharing Disclosures

You are enrolling in a Health Care Sharing Ministry administered by Kingdom HealthShare Ministries, LLC. A Health Care Sharing Ministry is not health insurance, and this program does not guarantee or promise that your medical bills will be paid. A Health Care Sharing Ministry is a group of individuals who share a common set of ethical or religious beliefs and share medical expenses in accordance with those beliefs.

The members of this Health Care Sharing Ministry voluntarily share medical expenses with one another, and Kingdom coordinates this medical sharing. This program should not be considered as a substitute for an insurance policy. You are always liable for your own unpaid medical bills.

 

DISCLAIMER

KINGDOM IS NOT AN INSURANCE COMPANY AND DOES NOT OFFER ANY INSURANCE PRODUCTS OR POLICIES.  KINGDOM DOES NOT ASSUME ANY RISK FOR YOUR MEDICAL EXPENSES, AND KINGDOM MAKES NO PROMISE TO PAY YOUR MEDICAL EXPENSES. 

KINGDOM OFFERS VOLUNTARY PARTICIPATION IN ITS HEALTH CARE SHARING MINISTRY AND COORDINATES ALL MINISTRY ADMINISTRATION SERVICES.   

No Promise to Pay

Kingdom does not make a promise to pay or any guarantee of payment of your medical expenses.  You are responsible for any unpaid medical bills.  Kingdom does not assume your risk.  Kingdom does not guarantee that your medical expenses will be shared by other members.

Voluntary Participation 

Enrollment in Kingdom is not a contract.  Participation in Kingdom is voluntary.  Enrollment as a Kingdom member is voluntary, and the sharing of monetary contributions is voluntary. You are free to cancel your membership at any time. Kingdom requests an Individual Share Amount to be collected for each month you are enrolled, to facilitate the payment of sharing requests published on behalf of other members.  

Guidelines 

Kingdom manages member sharing contributions by establishing guidelines that define which medical bills are eligible for sharing (“Guidelines”). The Guidelines are not a contract, and nothing presented by Kingdom constitutes a contract. The Guidelines do not constitute a legally binding agreement, a promise to pay, or an obligation to share. The Guidelines specify what type of expenses are eligible for sharing requests. Kingdom reserves the right to exclude sharing eligibility for any pre-existing conditions, whether disclosed at the time of your enrollment or discovered after the effective date of the membership.

Kingdom reserves the right to update and change its Guidelines at any time. 

Administration

Upon receiving an eligible medical bill from a member or provider, Kingdom will assign the bill for sharing in accordance with the Guidelines, less the amount required to be pre-shared paid by the member. Monthly member sharing contributions are called “Individual Share Amounts.” Up to 75% of Individual Share Amounts are applied towards administration of the Health Care Sharing Ministry, applied towards other charitable causes, or applied towards general overhead costs.

Membership Guidelines Details

Each member is responsible for reviewing the Guidelines provided at the time of enrollment, and to abide by the terms of the Guidelines.  It is your responsibility to understand which of your medical expenses are eligible for cost sharing, and which medical expenses are not eligible for cost sharing.  Members are also provided with a toll-free number to contact Member Services with any questions they may have. Preauthorization from Kingdom is required for certain medical expenses

 

 

 

Russell Dorfler  • Russ Dorfler  • Phone: (303) 932-1151  • Russ@eii4u.com

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