Program Change Form: New Programs Logo
  • Program Change Form

    For Current Solidarity HealthShare Members
  • Instructions


    Please use this form to notify Solidarity HealthShare that you would like to change your Membership program. 

    Before starting this form, be sure to have the followling available: 

    • Your Membership ID Card
    • The name of the Solidarity HealthShare program you would like to select
    • All program change requests require that notification is received by the first (1st) day of the month prior to the month in which the Member intends the program change to take effect. Program changes cannot be applied to a retroactive date.

    Important Note: This form will not accept any other Membership changes such as adding or removing Members. If you need to make any other type of Membership change besides selecting your new program, please reach out to the Member Care team at support@solidarityhealthshare.org.

  • Membership Account Information

    Please enter your current Membership account information below.

  • Contact Information Updates

    Use the fields below to update the contact information for your Solidarity HealthShare Membership.

  • Current Program Information

    Please provide the following information on your current Membership.
  • Program Details

    Please review the program options and then select the program you wish to change to.
  • Please review the program options available for Solidarity HealthShare. Depending on your specific Membership information, the Solidarity SAVVY program may not be available to you. Be sure to review the full program details in the Sharing Guidelines prior to making a selection.

    To check the current pricing for each program, including the optional add-ons, use the Solidarity HealthShare pricing calculator.

     

    Solidarity ONE Program

    Solidarity HealthShare's ONE program offers a wide-range of eligible services, flexible Annual Unshared Amount options, and the peace of mind that Members can live as healthy as possible.

    • Household type: Single, Couple, Family
    • 4 Annual Unshared Amount Options: $3,000, $6,000, $9,000 or $12,000
    • Program Includes*:
      • Wellness Visits and prevention screening
      • Co-Share Prescritpion Drugs and Supplments
      • Vaccines
      • Urgent Care
      • Telehealth
      • Dental and Vsion Discount Program
      • Mental Health Services
      • Maternity Services
      • Emergency Services
      • Hospitalization
      • Inpatient and Outpatient Surgery
      • Chiropractic

    *For more information and full program details visit: http://solidarityhealthshare.org/sharing-guidelines/program-solidarity-one

     

    Solidarity SAVVY Program

    Solidarity HealthShare SAVVY is a tailored program for single Members aged 18-29 years old and allows young people to receive quality care efficiently when they need it, without breaking the bank. 

    Features:

    • Household Type: Single (1 Member - age 18-29 years old only)
    • 2 Annual Unshared Amount Options: $3,000 or $12,000 
    • Program Includes*:
      • Wellness Visits and prevention screening
      • Urgent Care
      • Telehealth
      • Emergency Services
      • Hospitalization
      • Inpatient and Outpatient Surgery
      • Chiropractic
    • Optional Program Add-Ons:
      • $0 Co-Share Generic Medications
      • $0 Co-Share Acute Medications
      • Mental Health Services
      • Dental and Vision Discount Program

    *For more information and full program details visit: http://solidarityhealthshare.org/sharing-guidelines/program-savvy

     

    Solidarity SHIELD Program

    Solidarity HealthShare's SHIELD is a streamlined healthcare program for those who only need help if disaster strikes, but otherwise manage their health on their own. Limited to catastrophic needs and includes a high Annual Unshared Amount (AUA).

    Features:

    • Household Type: Single, Couple, or Family
    • Annual Unshared Amount: $12,000
    • Program Includes*:
      • Urgent Care
      • Emergency Services
      • Hospitalization
      • Outpatient Surgery
    • Optional Program Add-Ons:
      • Telehealth
      • $0 Co-Share Generic Medications
      • Mental Health Services
      • Dental and Vision Discount Program

    *For more information and full program details visit: http://solidarityhealthshare.org/sharing-guidelines/program-shield

  • Need more help deciding on a program?

    For questions, contact Solidarity HealthShare at support@solidarityhealthshare.org.

  • Program Selection

    Select the new program available to you based on the information provided.
  • Program Effective Date

    Provide your desired Effective Date
  •  / /
  • Important Reminder: All program change requests require that notification is received by the first (1st) day of the month prior to the month in which the Member intends the program change to take effect. Program changes cannot be applied to a retroactive date.

  • Annual Unshared Amount (AUA)

    Select the Annual Unshared Amount for your Solidarity ONE Program selection.
  • Annual Unshared Amount (AUA)

    Select the Annual Unshared Amount for your Solidarity SAVVY Program selection.
  • Prescription Choice (optional)

    If you would like to add Prescription to your Solidarity SAVVY Program, select one of the following options.
  • Add-Ons (optional)

    Select the Add-on(s) you would like added to your Solidarity SAVVY Program selection.
  • Annual Unshared Amount (AUA) Acknowledgment

    Note: For the Solidarity SHIELD Program, the Annual Unshared Amount is set to $12,000 AUA.
  • Add-Ons (optional)

    Select the Add-on(s) you would like added to your Solidarity SHIELD Program selection.
  • REVIEW YOUR PROGRAM CHANGE

    A summary of your Membership information and new program selection can be reviewed below. To make any changes to the information, click the back button at the bottom of the screen.
  • Membership ID: {MemberID}

    Current Membership Information:

    Primary Member Name: {primaryMemberName}

    Email on Membership: {primaryEmail}

    Phone: {phoneNumber}

     

    Updated Contact Information (if added)

    Updated Address: {updatedAddress}

    Updated Phone Number: {updatedPhoneNumber}

    New Email for Membership: {updatedEmailAddress}

    *NOTE: Updating your Membership Email will change the login email for the Member Care Portal*

     

    Your New Program Selection

    • Program Selection: {programSelectionIncludesSAVVY}{programSelectionONEandSHIELDonly}
    • Household Size: {householdSize}
    • Desired Effective Date: {desiredEffectiveDate}
  •   Solidarity ONE Program Options  

    • Annual Unshared Amount selection: {ONEprogramAUAselection}
    • Included Add-Ons:
      • Telehealth
      • Mental Health
      • Dental & Vision discounts
      • Drexi Prescription Co-Share
  •   Solidarity SAVVY Program Options  

    • Annual Unshared Amount selection: {SAVVYprogramAUAselection}
    • Prescription selection: {SAVVYprescriptionOptions}
    • Add-Ons: {SAVVYprogramAddons}
  •   Solidarity SHIELD Program Options  

    • Annual Unshared Amount selection: {SHIELDprogramAUAacknowledgment}
    • Add-Ons: {SHIELDprogramAddons}
  • Telehealth and Dental and Vision Discount Add-On Disclosure

  • Because you selected Telehealth or the Dental and Vision discount program as an add-on to your new program, please review the following requried agreements related to these services.

  • DialCare Terms & Conditions

    Terms and Conditions:  The Terms and Conditions you have accepted or will accept upon registering at www.dialcare.com, are part of this membership agreement (Agreement) between you and DialCare, LLC (“DialCare”). DialCare provides administrative services to DialCare clinicians and does not provide professional medical services.  The Terms and Conditions define the obligations of DialCare, its authorized agents and yourself, and they establish the basic rules of safe and fair use of DialCare’s public website, member website, and services (Services). DialCare and its authorized agents reserve the right to immediately and without advance notice terminate the Services and deny access to individuals who do not abide by the Terms and Conditions.

    Purchase and Renewal Conditions: By joining a plan, for yourself or on behalf of a minor child for whom you are a parent or legal guardian, you confirm that you are at least 18 years old and you authorize Solidarity HealthShare to charge your credit card or checking account for the plan you have selected. By joining, you indicate you have read and agree to the terms and conditions of the plan.

    This charge will automatically renew at the end of your membership term, and your credit card or checking account will be automatically charged for the appropriate amount, until you notify Solidarity HealthShare that you wish to cancel the plan.

    Termination Conditions: Solidarity HealthShare and DialCare reserve the right to terminate plan members from its plan for any reason, including non-payment. If Solidarity HealthShare terminates the plan or your membership for a reason other than non-payment, you will receive a pro-rata refund of your membership fees.

    Cancellation Conditions: You have the right to cancel within the first 30 days after effective date or receipt of membership materials (whichever is later) and receive a full refund, less the processing fee, if applicable. If for any reason you wish to cancel, submit a cancellation request with your name and member ID by mail to Solidarity HealthShare, 4500 S. Lakeshore Drive, Ste 130, Tempe AZ 85282 or phone. Solidarity HealthShare will stop collecting membership fees in a reasonable amount of time, but no later than 30 days after receiving a cancellation request. When you cancel, you will continue to have access to the plan for the remainder of the period for which you have paid; your membership will terminate at the end of that period. The preceding sentence does not apply to quarterly, semi-annual or annual memberships in FL and OK, where you will receive a pro-rata refund whenever you cancel.

    Description of Services: Please see the enclosed materials for a specific description of the programs included in your plan.

    Limitations, Exclusions and Exceptions: This is a discount plan offered by Careington. Careington is not a licensed insurer, health maintenance organization or other underwriter of health care services. This plan is not insurance. No portion of any provider’s fees will be reimbursed or otherwise paid by Careington. Careington is not licensed to provide and does not provide health care services or items to individuals. You will receive discounts for services at certain health care providers who have contracted with the plan. You are obligated to pay for all health care services at the time of service. Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased. Please verify such services with each individual provider. The plan’s discounts may not be used in conjunction with any other discount plan or program. All listed or quoted prices are current prices by participating providers and subject to change without notice. Any procedures performed by a non-participating provider are not discounted. From time to time, certain providers may offer products or services to the general public at prices lower than the discounted prices available through this plan. In such event, members will be charged the lowest price. Discounts on professional services are not available when prohibited by law. This plan does not discount all procedures. Providers are subject to change without notice and services may vary in some states. It is your responsibility to verify that the provider participates in the plan. At any time Careington may substitute a provider network at its sole discretion. Careington cannot guarantee the continued participation of any provider. If the provider leaves the plan, you will need to select another provider. Providers contracted by Careington are solely responsible for the professional advice and treatment rendered to members and Careington disclaims any liability with respect to such matters

    Complaint Procedure: If you would like to file a complaint, you must submit your complaint in writing to:  DialCare, P.O. Box 2568, Frisco, TX 75034. You have the right to request an appeal if you are dissatisfied with the complaint resolution. After completing the complaint resolution process, if you remain dissatisfied you may contact your state insurance department. Contact information for your state insurance department is available upon request. 

  • Program Change Acknowledgment

    Please review and accept the statements below regarding your program change.
    1. I have recorded my Membership information accurately to the best of my knowledge.
    2. I reviewed my program change request and accept the change.
    3. I understand that if I select a new program, my Annual Unshared Amount will reset to $0.00 on my new Effective Date.
    4. I understand that I can only make one (1) Membership Program change during my current Membership year.
    5. I understand that I cannot change my Membership Program from a higher Annual Unshared Amount to a lower Annual Unshared Amount during my current Membership year.
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