Please use this form to notify Solidarity Healthshare that you would like to change the Primary Member on your Membership or roll off a current Member of your Membership to a new Solidarity HealthShare Membership: Primary Member or Roll-Off Membership Change Form
Important changes that will be made and things to note as a result of completing this form:
- New Member ID#
- New Membership Program
- New Effective Date
- New Monthly Contribution Amount (MCA)
- New Annual Unshared Amount (AUA)
- AUA set to $0 accrued
- New Member Care Portal (MCP) account will have to be activated
- Continuation of Current Pre-Existing Condition(s) Timeline(s), if applicable
- Waived 60-Day Wait Period
- Waived $135 Application Fee
Reminder: All Membership changes need to be received by the first day of the month prior to the month that you would like the changes to take place. Membership changes cannot be applied to a retroactive date.