Request More Information

To find out if you qualify for Medi-Share, please

complete this form or call (800) 772-5623

You must be a legal U.S. resident and have been tobacco free for the last 12 months:

First Name:*

Last Name:*

Email*

Home Phone*

Address:*

City:*

State*

Zip Code*

Have you ever been treated for the following:

Stroke
Diabetes

HIV
Organ Transplant

Are you pregnant?*

Yes No

Are you over 65 years of age?*

Yes No

How did you hear about us?*

When are you looking for healthcare?*

Best time to contact*

* = Required Field

Medi-Share is not available in Montana. Christian Care Ministry, Inc. is a Florida not-for-profit corporation qualified under Section 501(c)3 of the Internal Revenue Code. The Medi-Share® program is the trademarked and official title of Christian Care Ministry’s Medi-Share program. For readability purposes, however, the program may be referred to simply as “medishare.” Medi-Share is not insurance. It is a not-for-profit ministry and is not guaranteed in any way. Medi-Share is exempt from regulation. The following states require a notice for Medi-Share to qualify for an exemption from insurance regulation. While Medi-Share is not insurance and therefore, need not qualify for such exemptions, CCM has elected to publish these exemptions. You can review the disclosure required by clicking on the state in which you reside: KY - MD - PA - WI - All Other States