• MightyWELL Health Employee Enrollment

    Affordable, Flexible, Transparent, Robust
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    • Company Information  
    • Company Contact

  • Click on next, if no spouse

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  • Click next, if no child(ren)

    • Click to open first child's application 
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    • Click to open second child's application  
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    • Click to open third child's application 
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  • ENROLLMENT SELECTION

  • ACKNOWLEDGEMENTS FOR THOSE ENROLLING IN ZION HEALTHSHARE

    Please Read & initial
  • Providing us with authorization to email and text you will allow Zion HealthShare to exchange information with you more

    efficiently and will benefit you as a member. At the same time, we recognize that email and text messaging are not a

    You are not required to authorize the use of email and text messages and a decision to not authorize electronic communication will not affect your health care in any way.

    We have taken considerable effort to protect the personal health information of our members, and recommend that all members provide us with this authorization so that we can more efficiently communicate with them.

  • Pre-Membership Medical Conditions Limitations

  • Any illness or accident for which a person has been diagnosed, received medical treatment, been examined, taken medication, or had symptoms for 24 months prior to the Effective Date. Needs that result from a pre-membership medical condition that existed pror to a Member's Effective Date (known or producing observable sysmptoms) are only shareble if the condition appears to be fully cured and 24 months have passed weithout any symptoms (either bening or deleterious). treatment, or medication, even if the cause of the symptons is unknown or misdiagnosed.

  • Waiting Period

  • In the first year of Membership, pre-existing conditions have a waiting period and are not sharable with the Zion Healthshare community yet. After the first year of continuous Membership, uo to $25,000 can be shared with thecommunity. After the second year of continuous Membership, up to $50,000 can be shared with the community. After the third year of continuous Membership and going forward, up to $125,000 can be shared with the community.

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  • MightyWELL Representative

  • Signature

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