Altrua HealthShare Representative Certification Program

1. 2018 / 2019 Representative Certification

2. Curriculum Expectations • Minimum passing score is 85%. • You have as much as 2 hours to complete the exam. • You may utilize all electronic and printed resources provided to you for study and preparation for the test. • Upon completing this curriculum with a passing score on the test of 85%, each representative will be properly and adequately trained and certified to offer Altrua HealthShare to qualified individuals and families. Exclusively for Representative Training and Certification use only

3. Overview of Altrua Ministries/Crown HealthShare Administrators • Altrua Ministries has been in existence since 1999 • Altrua Ministries (dba Altrua HealthShare) is a 501(c)(3), operated by Crown HealthShare Administrators, Inc. • NOT health insurance, instead a recognized Health Care Sharing Ministry, HCSM by CMS under the Affordable Care Act, which means members are eligible for an exemption from the shared responsibility payment (income tax penalty) • Altrua is a CMS recognized Healthcare Sharing Ministry, a recognized alternative to traditional health insurance. • What separates Altrua from the other HCSM offerings • Operates under a Statement of Standards not a Statement of Faith • Therefore, not tied to one specific faith/religion as other HCSM programs are • Altrua can be offered to prospective members nationwide • Member needs are paid from an Escrow Account not individually shared member to member

4. Altrua members are called to abide by the “Statement of Standards” • I agree to live a clean and healthy lifestyle and share the following • ethical or religious beliefs : • I believe in caring for one another. • I believe in keeping my body clean and healthy with proper nutrition. • I believe the use of any form of tobacco, illicit drugs and excessive alcohol • consumption is harmful to the body and soul. • I believe sexual relations outside the bond of marriage is contrary to the teachings • of the Bible and that marriage should be held in honor. • I believe abortion is wrong, except in a life-threatening situation for the mother. • I believe it is my obligation to care for my family, and that physical, mental, or • emotional abuse of any kind to a family member, or to anyone else, is morally wrong. Exclusively for Representative Training and Certification use only

5. HCSM programs are NOT health insurance • Members are considered by the medical profession to be self-pay patients • Members/Providers are required to first contact Altrua for pre-authorization of service • for all NON Emergency medical needs. • Typically, shared costs are lower negotiated costs for services than are charged to health insurance • companies • Some individuals may not be eligible or have a membership limitation due to certain past medical • history or present medical conditions. • HCSM were born in the early 1980’s, they have grown and thrived over the past 30+ years as an alternative to traditional health insurance ever rising costs and skyrocketing health care costs • Members do not participate in subsidizing or paying for certain lifestyle choices others make which continue to add to the rising costs of traditional health insurance • Today more than 1,000,000 Americans participate in HCSM and more are joining across America every day according to the Alliance of Health Care Sharing Ministries Exclusively for Representative Training and Certification use only

6. Overview and Disclaimer • Medical needs are shared and members eligible needs are reimbursed out of an escrow account member contributions are paid into monthly • Membership is not into an insurance company and does not guarantee or promise that eligible medical needs will be shared by the membership • To date all eligible medical needs on behalf of the membership have been shared • Eligible medical needs the membership is unable to share will remain the financial responsibility of the member should the program cease to operate • This program is an opportunity for like minded members to care for one another in a time of need • This program is not insurance and it is not a legally binding agreement to reimburse any member for medical needs Exclusively for Representative Training and Certification use only

7. Commonly used and understood Guideline & Application Terms • Application Date – the date Altrua receives a completed application • Contributor – person named as head of household under the membership • Escrow Instructions – contained on the membership application outlining the order in which voluntary monthly contributions may be shared by AltruaHealthShareie: Operating Expense – Member Needs – Liquidation Cost • Full-time Service Volunteer – person eligible as a dependent covered household member. Who, without receiving a salary, contributes services on behalf of a charitable or religious organization • Guidelines – an outline for eligible medical needs in which contributions are shared in accordance with the membership escrow instructions • Maternity Form – must be submitted within 30 days of confirmation of pregnancy • Member(s) – person or persons who qualify to receive voluntary sharing of contributions for eligible medical needs according to the membership escrow instructions, guidelines and membership type Exclusively for Representative Training and Certification use only

8. Commonly used and understood Guideline & Application Terms • Membership Commitment Form – signed and submitted annually to demonstrate commitment to membership requirements • Membership Limitation – A specified medical condition for which medical needs arising from or associated with the condition are ineligible. An associated condition is one that is caused directly and primarily by the medical condition that is specifically ineligible. The membership limitation will be issued during the application process, and may be subject to medical review. Membership limitations do not apply to office visits/urgent care. • Member Responsibility Amounts (MRA) – The amounts of an eligible need that do not qualify for sharing because the member is responsible for those amounts. • Monthly Contributions – Monetary contributions, excluding the annual membership fee, voluntarily given to Altura Healthshare, to hold as an escrow agent, and to disburse accordingly to the Escrow Instructions. • Needs– Charges or expenses for medical services from a licensed medical professional (M.D., D.O. N. D. Chiropractor, P.T., P.A., etc.) or facility due to illness, accident, or injury for a single member. • Usual, Customary and Reasonable (UCR) – The lesser of the actual charge or the charge most other providers would make for those or comparable services or supplies, determined by Altrua HealthShare. Exclusively for Representative Training and Certification use only

9. Representative Certification 2018 / 2019 Module 1 “Program Basics & Sharing Limits”

10. Membership Qualifications • Application – Process and Procedure • An application MUST be submitted electronically through the representative or consumer portal by the 25th of the month for an effective date the 1st of the following month. (example May 25th is the deadline for a June 1 effective date) • Member is Drafted $100 Application fee and the $25 Ministry Donation upon submission (non refundable) • Initial membership due is drafted between 1st-5th of the month following the approval of their application. (1st monthly contribution – will be refunded (If cancelled before the effective date.) • Members reoccurring draft occurs between the 1st – 5th of each month thereafter. • Beginning the second year of membership, members are responsible for an annual membership due of $100 • Payment Methods • ACH – no fees – except if rejected by financial institution • Credit Card – 3% fee per transaction (on Altrua website) Changes to existing plans must be in by the 15th of the month for a 1st of the month effective change Exclusively for Representative Training and Certification use only

11. Membership Qualifications • Membership with Limitation means: • The prospective member has (a) specific medical condition(s) which are not eligible for sharing. • As a rule, pre-existing conditions will have a 2 year limitation for sharing with the exception of a handful of conditions that receive a 5 year limitation. • The Prospective member has (a) specific routine preventative screening that must be completed *(see page 22)* • The prospective member has the right to decline the membership with limitation • The Application fee - (non-refundable) • Altrua Ministry donation - $25 (non-refundable) • 1st monthly contribution – will be refunded (If cancelled before the effective date.) • Changes to membership • Changes to existing plans must be made by the 15th of the month for changes to be effective the 1st of the following month. Exclusively for Representative Training and Certification use only

12. Membership Qualifications • Medical History – Overview • Review of automatic decline conditions • Certain medical conditions may result in a pre-existing waiting period or membership limitations • If approved for membership, pre-existing medical conditions NEVER result in a rate increase • Review of Height – Weight – guidelines • Member falling outside of normal Height & Weight guidelines can result in a rate up for membership or auto decline. Members falling outside of the normal Height & Weight is the ONLY way a member will receive a rate increase. When it is discovered that a prospective member or active member did not provide complete and accurate medical history or information • Membership can be declined • A retroactive membership limitation can be implemented • Active membership can be retroactively declined • Send email to enrollment with any health conditions that have been forgotten. A membership limitation can be removed with appropriate medical evidence Exclusively for Representative Training and Certification use only

13. Membership Qualifications • Dependents - Qualifications • Who qualifies: • Spouse living under the same roof • Newborn of the spouse/mother with an eligible maternity. Otherwise newborn/mother can be added with an Add On Application after 30 days from delivery. • Children under the age of 23 • Adopted children • Older dependents due to medical conditions verified by a qualified health professional • Once no longer meeting the dependent qualifications, one has to apply for individual membership to continue as a member • Waiting periods and pre ex limitations will not start over if no laps in benefit occurs • It is the head of household responsibility to ensure all dependents meet and comply with the Statement of Standards and membership guidelines Exclusively for Representative Training and Certification use only

14. Membership Qualifications Needs arising from a defined and disclosed listing are NOT eligible • Any need for which a pre ex limitation is in place are ineligible for sharing. • Any medical need that requires preauthorization (including surgery) within the first 90 days of your membership effective date, unless the medical need is for an emergency room-related accidental injury, emergency room-related life-threatening symptom, or emergency-room related eligible surgery that has occurred after the effective date • Lifestyles or activities engaged in after the application date that conflicts the Statement of Standards and/or Membership Guidelines • Elective abortion of a viable fetus/embryo, unless medically necessary to protect the mother’s life • Infertility testing or treatment, as well as any birth control measures to prevent conception • Maternity resulting from adultery or fornication by the member • Hysterectomy without securing two independent medical opinions. Both must agree to the medical need • Chiropractic is not eligible within 12 months of effective date • Physical Therapy is not eligible with 12 months of effective date unless it accompanies and eligible surgery accidental injury that occurred after the effective date. Exclusively for Representative Training and Certification use only

15. Membership Qualifications Needs arising from a defined and disclosed listing are NOT eligible • Hospital stays exceeding 60 days (fyi..medicare is 90) • Purchase or rental of durable or reusable equipment or devices (DME), including associated supplies or office visits • Psychiatric or psychological counseling, testing, treatment, medication and hospitalization • Mental or psychiatric health, learning disability, developmental delay, autism, behavior disorders, eating disorders, neuropsychological, testing, alcohol/substance abuse counseling, attention deficit disorder or hyperactivity • Second surgeries on previously eligible surgical needs are ineligible UNLESS; (i) Member has unexpected and provoked emergency situation within 30 days of first surgery (ii) The member’s provider has established, prior to initial surgery, that one or more follow up surgeries with be required to fulfill the treatment of the condition. This is subject to review by a licensed medical professional. • Handling charges, conveyance fees, STAT fees, shipping/handling fees, administration fees, missed appointment fees, telephone/email consultations, and after-hour fees. • Personal aircraft including; hang gliders, parasails, parasails, ultra lights, hot air balloons, sky diving, and any other aircraft not operated by a commercially licensed public carrier. • Extreme sports or activities perceived as high level of danger. (see page 32 of Altrua Member Guidelines) Exclusively for Representative Training and Certification use only

16. Sharing Limits • Total eligible needs shared from escrowed funds are limited as defined in this section and as further limited in writing to the individual member • Lifetime Limit – The maximum amount shared for eligible needs over the course of an individual member’s lifetime participation in the program. – currently $1,000,000 • Annual Limit – The maximum amount shared for eligible needs per member per calendar year of participation in the program – currently: • Altrua Select Silver – No Annual Limit • Standard Gold – No Annual Limit • Standard Silver – No Annual Limit • Standard Bronze =$250,000 • Copper Plan = $150,000 • Membership Responsibility Amounts (MRA) • Plan MRA – The annual out of pocket amount a member is responsible to pay for medical needs eligible for sharing under their membership • Office Visit MRA (standard plans) – The member will pay a $35 MRA of which does not applies towards meeting the overall Plan MRA (Costs exceeding $300 during an office visit are not eligible for sharing and do not apply to the Plan MRA.) • Pre-payment of Services – Members pre-paying at time of service without providing Altrua the opportunity to discount eligible needs, will only have those needs shared at 50%. Pre-authorization is the only exception Exclusively for Representative Training and Certification use only

17. Sharing Limits • Total eligible needs shared from escrowed funds are limited as defined in this section and as further limited in writing to the individual member • Recreational Activity Limits – All medical needs related to interscholastic, intercollegiate, league, and or community -or- church organized team sports or programs, limited to $10,000 of sharing. • Extreme Sports Limitation – Sharing Excluded, See page 32 of 2018 Altrua Membership Guidelines. • Recreational Vehicles – Injuries resulting from a recreational vehicle will be shared up to a maximum of $10,000.00 per need. A Needs Processing Form is required before Altrua HealthShare will share on the member’s behalf. A recreational vehicle is a licensed or unlicensed motor vehicle operated on land or water (including ATVs, snowmobiles, motorized scooters, boats, jet skis, etc.) or a licensed motor vehicle with less than four wheels (including motorcycles) excluding motor homes, 5th wheels, and bumper pull RVs. The vehicle’s operator(s) must be insured by a third party for any needs to be eligible. Altrua HealthShare will only consider the needs eligible once they have been processed by the liable third party. • Members participating in the activities listed above are encouraged to purchase an additional accident plan. Exclusively for Representative Training and Certification use only

18. Sharing Limits • Organ Transplant Limit – Eligible needs may be shared up to a maximum of $150,000 per member not to exceed the maximum sharing limit per membership type • Home Infusion Therapy Limit – Eligible needs may be shared up to a maximum of 50% of allowed charges • Other Resources – Needs do not qualify for sharing to the extent that they are discountable by the provider or payable by an institutional source such as insurance, VA/Tricare, private grants or by a liable third party. If the member does not cooperate fully and assist Altrua in determining if the need is discountable or payable by another party, the need will not be eligible for sharing. • Sharing of monthly contributions for a need that is later paid or found to be payable by an institutional source or a liable third party will automatically allow Altrua full rights to recover from the member the amount shared on their behalf • Altrua will be secondary to other health coverage members have. Altrua will require a copy of the other carrier’s EOB in order to determine what sharing will consist of. Exclusively for Representative Training and Certification use only

19. Sharing Limits • Total eligible needs shared from escrowed funds are limited as defined in this section and as further limited in writing to the individual member • Non-Emergency Surgery, Procedure or Test – The member must have the procedures or services pre-authorized as medically necessary prior to receiving the service. Failure to comply with this requirement will render the service not eligible for sharing. • ER Visits, Emergency Surgery, Procedure or Test- Non-emergent use of the emergency room is ineligible. • Use of emergency room for non-urgent medical needs is ineligible for sharing unless treatment at an emergency room is the only legitimate option because of the severity of the condition and lack of availability of treatment at an alternative facility.  • Medical records will be reviewed for all ER visits to determine eligibility, An emergency is defined as treatment that must be rendered to the patient immediately for the alleviation of the sudden onset of an unforeseen illness or injury that, if not treated, would lead to further disability or death. Examples of an emergency include, but are not limited to; sever pain, choking, major bleeding, heat attack or a sudden unexplained loss of consciousness. Exclusively for Representative Training and Certification use only

20. Eligibility for Cancer Needs Members are required to contact Altrua within 30 days of Cancer diagnosis or be responsible for 50% of allowed charges after MRA(s) • Cancer is ineligible for sharing during the first 12 months of membership • This includes diagnostic testing • In order for needs related to ANY type of cancer to be eligible (e.g. breast, cervical, ovarian, endometrial, prostate, etc.) • Female members, age 40 and over, are required to get screening tests every two years from the date of the last negative result, while on the membership: mammogram, or ultrasound in place of mammogram, and pap-smear with pelvic exams for female members. Male members, age 50 and over, are required to get a PSA blood test every two years from the date of last negative test result. Failure to obtain the biennial tests will render future needs listed above as ineligible. The biennial tests must be performed within 24 months of their last clean test result and submitted to Altrua HealthShare. • For new members, the aforementioned cancers will be eligible for sharing 12 months after the receipt of clean test results Altrua HealthShare within 30 days from the member’s effective date. If the new member does not submit the clean test results within 30 days, the aforementioned cancer will be eligible for sharing 12 months from the date the clean test results were received by Altrua HealthShare. Members may use test results completed within 6 months of the effective date Exclusively for Representative Training and Certification use only

21. Sharing Limits MATERNITY • Not eligible for mothers who “conceive” within their first 10 months of membership. • Not Eligible for out of wedlock pregnancies • Only Eligible to memberships with 2 lives and larger (1 life memberships not eligible for maternity sharing) • Only Eligible on Standard Gold & Silver Plans • Not Eligible on Select Silver • NOT eligible on Bronze & Copper • Needs for maternity are limited to $4,000 per pregnancy (whether for a single or multiple birth or for any type of miscarriage) with no MRA applicable • Needs for maternity ending in a delivery by cesarean section that is either medically necessary because of complications that arise at the time of delivery or due to medical necessity from previous cesarean section delivery are limited to $6,000 with no MRA applicable. • Once pregnant the member must notify Altrua to determine eligibility criteria have been met. • Maternity benefits do not apply to adoption • If a member elects to use a mid-wife the mid-wife must be tested for group B strep prior to delivery. Failure to do this will result in failure of needs to be shared • Needs for maternity involving complications that threaten the life of the mother or the infant and requiring care or services not normally rendered at the time of delivery are not limited but are subject to meeting the MRA’s. • Complications of pregnancy or medical needs for the newborn beyond routine hospital care are not subject to maternity sharing limits. • A complication of pregnancy is a disease or condition that is distinct from pregnancy but is adversely affected or caused by pregnancy, and occurs during the pregnancy and not just at the time of labor or delivery. • Complications of pregnancy does not include false labor, spotting, doctor prescribed rest, morning sickness, etc • The newborn will be eligible to participate, 30 days after delivery, subject to the application process Exclusively for Representative Training and Certification use only

22. Denied Needs • If a need is denied as not eligible, and there is a dispute, the aggrieved member or any other aggrieved party may seek reconsideration only through the appeal procedure described herein. • Appeals • Most situations can be resolved simply by calling a Member Services Representative at Altrua. The matter will be reviewed and can usually be resolved within 10 business days. Denials due to a retroactive decline for membership or a membership limitation are only reviewed if the aggrieved party submits a formal appeal. • The aggrieved party may formally appeal any denied need by following the established formal appeal procedure which requires a formal appeal to be in writing and an appeal fee to be deposited with Altrua. • The appeal is first reviewed by a supervisor, then if necessary by the Altrua Appeals Board. • If the original denial is upheld, the appeal fee is not returned. If the denial is overturned, an amount equal to double the total of all appeal fees deposited will be returned to whoever made the appeal. • To have any degree of merit, an appeal should address at least one of the following three questions: • What information does Altrua have that is either incomplete or incorrect? • How do you believe Altrua has misinterpreted the information already on hand? • What provision in the Altrua guidelines do you believe Altrua applied incorrectly? Exclusively for Representative Training and Certification use only

23. Members Rights and Responsibilities • Member Rights: • Receive considerate, courteous service with respect for personal privacy and dignity • Receive accurate information regarding membership guidelines • Have needs processed accurately once all necessary documentation has been received • Member Responsibilities: • Ask questions and make certain that you understand the explanations and instructions you are given • Ask questions and understand the consequences of refusing a recommended medical treatment. • Refusal of treatment may mean future medical needs will not be eligible for sharing Exclusively for Representative Training and Certification use only

24. Representative Certification 2017 Module 2 “Altrua Plans & Rates”

25. . Exclusively for Representative Training and Certification use only

26. SELECT SILVER 2,750 If your family is larger than five, add $50 more for each additional family member. If husband and wife are both participating, “head-of-household” is based on the older spouse’s age. Exclusively for Representative Training and Certification use only

27. Copper Plan $7,500 MRA Exclusively for Representative Training and Certification use only *Additional $50 per month per dependent over 3 family members

28. Select Silver 2,750 All Altrua eligibility requirements apply • Select Silver DOES NOT • Offer wellness visits • Primary Care Visits • Urgent Care Visits • Unlimited Telemedicine Included, $0 per visit. • Specialist visits are eligible for sharing when prescribed for treatment specifically related to the recovery of a member who has had an eligible catastrophic event or major surgery. ( up to 6 visits tied to the medical event) • Physical therapy and occupational therapy visit eligible for sharing up to 20 combined visits per year after a 12 month waiting period unless associated with an eligible surgery or eligible accidental injury. (MUST be pre- authorized) • Maternity not eligible for Sharing. • (NO Network) for Lab, Hospitalization, Out-patient Care; RBP re-pricing applies

29. STANDARD PLANS • All Altrua eligibility requirements apply (see “Program Basics” starting on page 28) • Members are eligible to use the “PHCS Practitioner Only” PHCS Network for office visit discounts. https://www.multiplan.com/search/search-3-Provider.cfm?originator=84485 • Up to 6 Office Visits per Year with Sharing up to $300 per visits w/ $35 MRA. Costs exceeding $300 Do Not apply to MRA. (Except Bronze, applies to MRA only) • Physical therapy and occupational therapy visit eligible for sharing up to 20 combined visits per year after a 12 month waiting period unless associated with an eligible surgery or eligible accidental injury. (MUST be pre- authorized) • Maternity is Eligible for Sharing (See Maternity Limitations on Slide 21) • Telemedicine Not Included • Lab, Hospitalization, out-patient care; RBP re-pricing applies Exclusively for Representative Training and Certification use only

30. Copper Plan 7,500 • There is no age banding to this product and will cease at the age 65 • All Altrua eligibility requirements apply (see “Program Basics” starting on page 28) • Network Discount given to member • Payments made for office visits applied to annual MRA • All office visits are within PHCS or Altrua Network (www.Multiplan.com) • Lab, Hospitalization, out-patient care; RBP re-pricing applies • Maternity is not eligible • Dependents over Age 20 must apply individually Exclusively for Representative Training and Certification use only

31. Representative Certification 2017 Module 3 “Ethics and Compliance”

32. Ethics & ComplianceRegional Member Representatives The purpose of these ethical and compliance guidelines is to establish that all representatives are expected to adhere to doing what is right and honorable in their public and private conduct. These guidelines establish and promote an understanding of professional conduct as representatives of Altrua HealthShare • Representatives should endeavor to place the public interest above their own • Representatives should seek continually to maintain and improve their professional knowledge, skills and competence. • Representatives should obey all laws and regulations, and should avoid any conduct or activity that would cause harm to others. • Representatives must carry a resident insurance license in order to represent Altrua HealthShare. Non resident licenses are not required. • Representatives should be diligent in the performance of their occupational duties and should continually strive to improve the functioning of the Health Care Sharing Ministries (HCSM) mechanism. Exclusively for Representative Training and Certification use only

33. Ethics & Compliance • Representatives should aspire to raise the professional and ethical standards in the Health Care Sharing Ministries (HCSM) system. • Representatives should strive to establish and maintain dignified and honorable relationships with those whom they serve, with fellow representatives and with members of other professions. • Representatives should assist in improving the public understanding of the Health Care Sharing Ministries (HCSM) and risk management. • Representatives should provide considerate and courteous service as well as respect personal privacy and dignity of all members and prospective members Exclusively for Representative Training and Certification use only

34. Ethics & Compliance • Representatives should ensure the application process is completed accurately with all needed information and documentation submitted correctly • Representatives must NEVER finance contributions, donations or fees themselves on behalf of the prospective members • Representatives must ensure prospective members receive appropriate documentation as defined in guidelines provided by the company • Representatives Must be aware the traditional E&O insurance policies typically DO NOT cover claims related to the sale of a HealthShare membership. It is highly advised representatives enroll in the E&O coverage offered through Altrua that will cover the sale of Altrua Health Share Memberships. This plan cost $15 /mo or $120 per year. Exclusively for Representative Training and Certification use only

35. Ethics & Compliance • Representatives will not call the program ‘insurance’ • Although it works similarly it is a HCSM, an approved alternative to traditional health insurance plans • Representatives will not use ‘insurance’ terminology • Although by definition many principals and procedures are similar the HCSM terminology ‘must’ be used at all times • Representatives will not say ‘guaranteed issue’ • A prospective member is accepted for consideration with Altrua acceptance of the application however medical information review must be completed before ‘full’ or ‘limited’ membership will be offered • Representatives will not say eligible needs will always be reimbursed • Only needs incurred on or after the membership effective date are eligible and subject to review for conditions and circumstances which have been declared as ineligible under membership guidelines Exclusively for Representative Training and Certification use only

36. Member Representatives Ethics • Representatives may • Prospect for prospective members as follows: • Health conscious members that adhere to a healthy standard of living (criteria must be met by each applicant to ensure that Altrua members are sharing with like-minded people who are free from addictions and unhealthy lifestyles) • Faith Based individuals and groups that focus on biblical principles • Churches – Private Schools – Non-profit organizations – Associations – Organizations • Individuals and families of all ages • Public and Private Business both small and large • Prospective applicants of Altrua are not limited to certain times of the year in which membership is available • Ask for referrals from family, friends, networking contacts and prospective Altrua members • Encouraged to offer separate benefits programs that can enhance the Altrua offering and address any concerns your member may have about plan limitations. (must be sold separately) Exclusively for Representative Training and Certification use only