• MightyWELL Health Employee Enrollment

    Affordable, Flexible, Transparent, Robust
    • Company Information  
  • Plan type and applicant family information

    • Click to add spouse to application or next to proceed 
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      Pick a Date
    • Click next, if no child(ren)

    • Click to add first child to application or next to proceed  
    •  - -
      Pick a Date
    • Click to add second child  
    •  - -
      Pick a Date
    • Click to add third child 
    •  - -
      Pick a Date
  • Benefit selection and plan specifics

  • Acknowledgements for enrolling in Zion HealthShare

    Please Read & Acknowledge
  • 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 completely secure means of communication.

    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 within the last 24 months prior to the Effective Date for which a person has

    • Had Symptoms
    • Been examined
    • Been diagnosed
    • Received medical treatment
    • Taken medication

    Medical 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 without any symptoms (either bening or deleterious). treatment, or medication, even if the cause of Symptoms are unknown or misdiagnosed.

  • Zion HealthShare membership Pre-Existing conditions first 12 month waiting period and subsequent phase in period

    • First 12 month period $0 
    • Second 12 month period up to $25,000
    • Third 12 month period up to $50,000
    • Forth 12 month period and each 12 month period there after up to $125,000 

    Shareable amounts listed above for pre-existing conditions require continious healthshare membership.

  • Questions for Custom Plan Design for individuals with pre-existing health conditions

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    • Click to provide explanation for yes answers 
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  • MightyWELL Representative

  • Applicant Signature

  • Clear
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    Pick a Date
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