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Knew Health’s Enrollment

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Name*





Email*





Date of Birth*

Gender*





SMS Optin



Address*










Unfortunately we’re not currently enrolling members in this state. But you can join our waitlist to get notified once we open enrollment.*





Does Not Satisfy MEC*

Knew Health does not satisfy a federal or state requirement for health insurance. As you live in a state with a mandate for health coverage, you are responsible for securing that coverage independently from your Knew Health Membership.



Please answer the following questions concerning pre-existing conditions:
Any medical condition that was suspected, symptomatic, diagnosed or required treatment within the 24 months prior to the effective date of membership is considered a pre-existing condition.

Have you had any symptoms of a medical condition, whether illness or injury, within the last 24 months?*





Have you been diagnosed with any medical condition, whether illness or injury, within the last 24 months?*





Have you had any medical care, whether had doctor’s visits, treatments, or medical monitoring for a condition within the last 24 months?*





Pre-existing conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-existing conditions are shareable. After the first year, pre-existing needs are eligible for sharing on a limited basis, with the amount increasing each membership year.

Shareable amounts for pre-existing conditions:

• Year One: $0 (waiting period)

• Year Two: $25,000 maximum per need

• Year Three: $50,000 maximum per need

• Year Four: $125,000 maximum per need

After year four of membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.

Are you or any dependents currently pregnant or trying to get pregnant?*

Pregnancies that have an estimated date of delivery that fall within the first year of Membership are not eligible to share.





Tobacco or smoked products include, but are not limited to cigarettes, e-cigarettes, cigars, chewing tobacco, snuff, vape products, pipe tobacco and smoked cannabis.

I'm interested in health sharing for…*









Spouse's Name*








Spouse's Date of Birth*

Spouse's Gender*





Please answer the following questions concerning pre-existing conditions of your spouse:
Any medical condition that was suspected, symptomatic, diagnosed or required treatment within the 24 months prior to the effective date of membership is considered a pre-existing condition.

Has your spouse had any symptoms of a medical condition, whether illness or injury, within the last 24 months?*





Has your spouse been diagnosed with any medical condition, whether illness or injury, within the last 24 months?*





Has your spouse had any medical care, whether had doctor’s visits, treatments, or medical monitoring for a condition within the last 24 months?*





Pre-existing conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-existing conditions are shareable. After the first year, pre-existing needs are eligible for sharing on a limited basis, with the amount increasing each membership year.

Shareable amounts for pre-existing conditions:

• Year One: $0 (waiting period)

• Year Two: $25,000 maximum per need

• Year Three: $50,000 maximum per need

• Year Four: $125,000 maximum per need

After year four of membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.

Child's Name*







Child's Date of Birth*

Child's Gender*





Please answer the following questions concerning pre-existing conditions of your child:
Any medical condition that was suspected, symptomatic, diagnosed or required treatment within the 24 months prior to the effective date of membership is considered a pre-existing condition.

Has your child had any symptoms of a medical condition, whether illness or injury, within the last 24 months?*





Has your child been diagnosed with any medical condition, whether illness or injury, within the last 24 months?*





Has your child had any medical care, whether had doctor’s visits, treatments, or medical monitoring for a condition within the last 24 months?*





Pre-existing conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-existing conditions are shareable. After the first year, pre-existing needs are eligible for sharing on a limited basis, with the amount increasing each membership year.

Shareable amounts for pre-existing conditions:

• Year One: $0 (waiting period)

• Year Two: $25,000 maximum per need

• Year Three: $50,000 maximum per need

• Year Four: $125,000 maximum per need

After year four of membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.


Child's Name*







Child's Date of Birth*

Child's Gender*





Please answer the following questions concerning pre-existing conditions of your child:
Any medical condition that was suspected, symptomatic, diagnosed or required treatment within the 24 months prior to the effective date of membership is considered a pre-existing condition.

Has your child had any symptoms of a medical condition, whether illness or injury, within the last 24 months?*





Has your child been diagnosed with any medical condition, whether illness or injury, within the last 24 months?*





Has your child had any medical care, whether had doctor’s visits, treatments, or medical monitoring for a condition within the last 24 months?*





Pre-existing conditions have a phase-in period wherein sharing is limited. Starting from the initial enrollment date, members have a one-year waiting period before pre-existing conditions are shareable. After the first year, pre-existing needs are eligible for sharing on a limited basis, with the amount increasing each membership year.

Shareable amounts for pre-existing conditions:

• Year One: $0 (waiting period)

• Year Two: $25,000 maximum per need

• Year Three: $50,000 maximum per need

• Year Four: $125,000 maximum per need

After year four of membership, expenses related to pre-existing conditions will remain shareable at a maximum of $125,000 in a 12-month rolling period and resetting each membership year.This field is for validation purposes and should be left unchanged.