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Become a Member (844) 412-3019
Become a Member (844) 412-3019

Member Activation

If available, who is your current primary care provider?

Plan ID (required)


HealthPass, PrimaCare Members Only

As a new member of Aliera Healthcare I understand the following limitations of the membership: 1. This is NOT insurance. 2. Annual physicals cannot be scheduled until 9 months after a Member’s effective date. All other benefits are available immediately after the Member’s effective date. 3. When a medical issue arises, a Member must contact a telemedicine provider first unless an obvious urgent situation is apparent. For urgent situations, Members are advised to go directly to an urgent care provider. 4. If a telemedicine provider cannot resolve the Member’s concern, the Member must contact Aliera’s Concierge Department to schedule an appointment with a Primary Care Physician (PCP).

YesNo
AlieraCare, InterimCare, CarePlus Advantage, Trinity HealthShare Members only

As a new member of Aliera Healthcare I understand the following limitations of the membership: 1. This is NOT insurance. 2. Annual physicals cannot be scheduled until 9 months after a Member’s effective date. All other benefits are available immediately after the Member’s effective date. 3. In addition to Aliera’s limitations, as a member of Trinity HealthShare, do you agree to the statement of beliefs as listed below: a) We believe that our personal rights and liberties originate from God and are bestowed on us by God. b) We believe every individual has a fundamental religious right to worship God in his or her own way. c) We believe it is our moral and ethical obligation to assist our fellow man when they are in need according to our available resources and opportunity. d) We believe it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors or habits that produce sickness or disease to ourselves or others. e) We believe it is our fundamental right of conscience to direct our own healthcare, in consultation with physicians, family or other valued advisors.

YesNo

You understand that this sharing plan has a 24-month waiting period for pre-existing conditions, where pre-existing conditions are defined as conditions that exist at the time of enrollment that have evidenced symptoms, received treatment, and/or medication within the past 24 months.

YesNo

You understand that other medical services and emergency surgical services are eligible for cost sharing immediately, but elective surgical services require a 60-day wait period (180-day for AlieraCare Value and AlieraCare Plus) following your effective date.

YesNo

You understand that Aliera Healthcare, Inc., and Trinity HealthShare, Inc. have the authority, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to request your medical records to facilitate the payment of medical expenses.

YesNo

Check the Health condition that apply to you. (required)

ArthritisAsthmaHeart DiseaseCongestive Heart FailureHeart Bypass SurgeryDepressionDiabetes Type IDiabetes Type IIChronic Heart Burn/GERDHigh CholesterolHigh Blood pressureIrritable Bowel DiseaseLower Back or Neck PainHeart AttackAIDS/HIVNone of the Above

List other conditions not listed above.

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