Representative Certification 2016

1. Representative Certification 2016 We will begin shortly, please have your copy of Power Point Training Presentation handy to take not Altrua HealthShare Information Booklet Height and Weight Guidelines sheet and Automatic Denials sheet Altrua Ministries is a 501 (c)(3) non-profit, (dba Altrua HealthShare) is a recognized Health Care Sharing Ministry (HCSM) under the Affordable Care Act. Members are exempt from the federal penalty imposed on those who do not have health insurance. Altrua HealthShare is a nationwide faith-based membership of individuals and families who uphold a Statement of Standards and share in each other’s medical needs according to membership guidelines. AltruaHealthShare is NOT insurance but is an alternative to the rising healthcare costs associated with health insurance plans. Because the ACA enrollment period is limited, failure to enroll during it can result in being ‘locked out’ of the ACA. People can enroll into Altrua HealthShare all year long with no time frame limitations. You will be learning new terminology regarding a Health Care Sharing Ministry, set aside terminology you are familiar with when dealing in traditional health insurance. AltruaHealthShare members commit to honoring the Statement of Standards as set forth on the membership application. AltruaHealthShare is not tied to one specific faith and is open to all walks of faith as long as the applicant can honor the Statement of Standards which is biblically and faith-based. All certified independent representatives need to be comfortable with and willing to embrace the same set of standards in order to professionally, ethically and honorably represent AltruaHealthShare. . Exclusively for Representative Training and Certification use only

2. Representative Certification 2016 Module 1 “Overview” Exclusively for Representative Training and Certification use only

3. Curriculum expectations and outcomes • Training will consist of 3 modules, followed by a multiple choice, 2 hour, time limited test. Minimum passing score is 84%. There will be a maximum of 3 attempts to pass the test. • Utilize all electronic and printed resources provided to you for study and preparation for the test. • Upon completion of this curriculum with a passing score on the test, each representative will be properly and adequately trained and certified to offer AltruaHealthShare to qualified individuals, families and groups. Exclusively for Representative Training and Certification use only

4. Altrua HealthShareWelcome and Understand • NOT health insurance, instead a recognized Health Care Sharing Ministry, HCSM, under the Affordable Care Act, which means members are eligible for an exemption from the shared responsibility payment (penalty) • A faith-based alternative solution to the problems of rising health care costs and expensive health insurance policies • No longer are people looking at the only option being reduced coverage and higher deductibles • Sharing ministries have been available for nearly 30 years Exclusively for Representative Training and Certification use only

5. History & Overview of Altrua Ministries/Crown HealthShare Administrators • Altrua Ministries has been in existence since 1999 • Owned and headquartered in Texas since 2005 by Director Randall Sluder • Altrua is a recognized HCSM with full exemption under the Affordable Health Care Act • Altrua Ministries (dba Altrua HealthShare) is a 501(c)(3), operated by Crown HealthShare Administrators, Inc. • What separates Altrua from the other HCSM offerings • Operates under a Statement of Standards not a Statement of Faith or Statement of Ethics • Therefore, not tied to one specific faith/religion as other HCSM programs are • Altrua can be offered to prospective members nationwide, as long as they will abide by the Altrua Statement of Standards, which sets it apart from the competition • Member needs are paid from an Escrow Account not individually shared member to member • Altrua offers its members and non-members a complete Health and Wellness program Exclusively for Representative Training and Certification use only

6. HCSM programs are biblically based. Altrua members are called to abide by the Statement of Standards as set forth in the member guidelines • Can you answer “Yes” to the following? • Do You: • Believe in caring for one another • Live a clean and healthy lifestyle • Affirm you have refrained from the use of tobacco and illegal use of drugs for at least, the past 12 months • Abstain from sexual relations outside the bond of marriage between a man and a woman • NOTE: Some individuals may not be eligible or have a membership limitation due to certain past medical history or present medical conditions. Exclusively for Representative Training and Certification use only

7. Statement of Standards: • Altrua operates off of a Statement of Standards, while other HCSM operate off of a Statement of Faith or a Statement of Ethics. By operating with a Statement of Standards, Altrua expands the potential member base due to the fact Altrua is not tied to one specific faith. The Altrua Statement of Standards is as follows: • Because of my biblical convictions, I choose to live a clean and wholesome life, and share the following standards and convictions with members of AltruaHealthShare. • I believe in keeping my body clean with proper nutrition and consuming foods in moderation. I believe that the use of tobacco, illicit drugs, and excessive alcohol consumption is harmful to body and soul. • According to the word of God sexual relations outside the bond of marriage between a man and a woman are morally wrong. • I believe that abortion is wrong, except in special circumstances such as rape or serious injury to the mother, and then, only after careful consideration by all concerned. • I believe that I am obligated to provide and care for my family and that abuse of any kind, of a family member or anyone else is wrong. Exclusively for Representative Training and Certification use only

8. HCSM programs are NOT health insurance • Members are considered by the medical profession to be self-pay patients • Typically, shared costs are lower negotiated costs for services than are charged to health insurance companies • 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 • Members have committed to living healthy and honorable lifestyles according to Godly principles Exclusively for Representative Training and Certification use only

9. Disclaimers and Legal Notice • 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 • 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 • Medical needs shared will be reimbursed from the escrow account all member contributions are placed into • See page 2 of the Information Booklet Exclusively for Representative Training and Certification use only

10. HCSM programs are NOT health insurance Exclusively for Representative Training and Certification use only

11. Altrua Standard Membership Types (Page 6-7 Information Booklet) GOLD STANDARD SILVER STANDARD Monthly Contribution Request for Altrua Standard BRONZE STANDARD *Member Responsibility Amount (Out of Pocket) Affiliated Provider: PHCS network www.multiplan.com **Non-Affiliated Providers office visit MRA is 50% of office visit 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. If head of household is 65 or over, contribution is based on younger spouse’s age. Office Visit MRA does not apply to 65+ Medicare plans.

12. Altrua Advantage Membership Types (Page 8-9 Information Booklet) GOLD ADVANTAGE SILVER ADVANTAGE Monthly Contribution Request for Altrua Advantage BRONZE ADVANTAGE 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. If head of household is 65 or over, contribution is based on younger spouse’s age. Office Visit MRA does not apply to 65+ Medicare plans. *Member Responsibility Amount (Out of Pocket) Affiliated Provider: PHCS network www.multiplan.com **Non-Affiliated Providers office visit MRA is 50% of office visit

13. Membership Qualifications • Medical History – Overview • 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 • A membership limitation can be removed with appropriate medical evidence • Dependents – Overview • Who qualifies: • Spouse living under the same roof • Children under the age of 20 • 20 – 24 year old • Full-time student • Full-time service volunteer Exclusively for Representative Training and Certification use only

14. Membership Qualifications • Financial Participation – Overview • Application fee - $100 - currently • Annual membership contribution - $100 – currently • Altrua Ministries donation - $25 – currently • Monthly membership type contribution Standard – Advantage – Gold – Silver – Bronze • A missed monthly contribution will result in that month’s eligible needs not being shared • An inactive membership can be reinstated when past due contributions are made within 90 days, the same as ACA plans • Eligible Needs – Overview • Only needs incurred on or after the membership effective date are eligible for sharing under the membership escrow instructions • Needs must be filed on appropriate forms and medical records may also be required from providers – Needs forms are available for download on the website • Needs arising from a defined and disclosed listing are not eligible • Which will be covered thoroughly in a subsequent training module • Appeals and Grievance Process – Overview • The established process will be covered thoroughly in a subsequent training module Exclusively for Representative Training and Certification use only

15. Definition of guideline and application terms Commonly used and understood terms, (refer to pages 12-15 in the Information Booklet Section I.-D. for the complete list of terms) • Affiliated Provider – contracted with the PHCS network, with whom Altrua works • Application Date – the date Altruareceives a completed application • Contributor – person named as head of household under the membership • Escrow Instructions – contained on the membership application (page 6) outlining the order in which voluntary monthly contributions may be shared by AltruaHealthShare • 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 Exclusively for Representative Training and Certification use only

16. Definition of guideline and application terms Commonly used and understood terms (refer to pages 12-15 in the Information Booklet Section I.-D. for the complete list of terms) • Guidelines – an outline for eligible medical needs in which contributions are shared in accordance with the membership escrow instructions • 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 • Membership Limitation – specified medical condition for which medical needs arising from or associated with the condition are not eligible for sharing. An associated condition is one that is caused directly and primarily by the medical condition that is specifically not eligible • Member Responsibility Amounts (MRA) – the amounts of an eligible need which are first paid by the member then eligible for sharing by the plan Exclusively for Representative Training and Certification use only

17. Definition of guideline and application terms Commonly used and understood terms (refer to pages 12-15 in the Information Booklet Section I.-D. for the complete list of terms) • Monthly Contributions – monetary contributions, excluding the annual membership contribution, voluntarily given to AltruaHealthShare to hold as an escrow agent and to disburse according to the membership escrow instructions • Needs – charges or expenses for medical services from a licensed medical practitioner or facility arising from an illness or accident for each member • Non-affiliated Provider – not a participating provider within the PHCS network • Usual, Customary and Reasonable (URC) – the lesser of the actual charge or the charge most other providers would make, as determined by AltruaHealthShare as baseline to pay out of network providers Exclusively for Representative Training and Certification use only

18. Perks of membership in AltruaHealthShare • Caring people who help others • Members are exempt from the Affordable Care Act • Different membership types to meet any budget • $1,000,000 lifetime benefit per family member • Help-A-Friend Referral Credit • For every member referral that joins and remains a member for 3 consecutive months, receive a Referral Credit. Amount will vary. • Health and Wellness Program • Under construction • Yearly Healthy Lifestyle Credit • One-time credit given in March of the year following an entire calendar year in which no claims were filed. Amount will vary based on membership type and monthly contribution amount. Exclusively for Representative Training and Certification use only

19. Representative Certification 2016 Module 2 “Ethics and Compliance” Exclusively for Representative Training and Certification use only

20. 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 AltruaHealthShare • 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 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

21. Ethics & ComplianceRegional Member Representatives • 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

22. Ethics & ComplianceRegional Member Representatives • Representatives should ensure the application process is completed accurately with all needed information submitted correctly • Representatives must submit full amounts of payments from prospective customers when completing an application for membership and may never finance contributions 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 will fully comply with Membership Guidelines when assisting prospective members to ensure plan eligibility is met Exclusively for Representative Training and Certification use only

23. Ethics & ComplianceRegional Member Representatives • 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 ever backdate an application • 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

24. Ethics & ComplianceRegional Member Representatives • Representative Commission Terms • Commissions are paid on the base monthly contribution only • Following the first six (6) months if the Representative incurs a loss ratio at or above 75%, Altrua shall have the right to • Terminate the agreement for cause • Reduce the Commission Rate With appropriate written notice to the Representative In Addition: • Following the first six (6) months if the Representative does not achieve a Monthly Net Contribution of at least $3000 with a loss ratio below 75%, the Company may • Reduce the Commission Rate Loss Ratios will be reviewed monthly, quarterly and annually during the term of the Representative Agreement Exclusively for Representative Training and Certification use only

25. Ethics Regional Member Representatives • 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 member 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 • Ask for referrals from family, friends, networking contacts and prospective Altrua members • Engage in marketing campaigns approved by Altrua • Expos, fairs, flea markets, farmers markets, social media, etc. Exclusively for Representative Training and Certification use only

26. Representative Certification 2016 Module 3 “Program Basics” Exclusively for Representative Training and Certification use only

27. History of Health Care Sharing Ministries (HCSM) • Bearing one another’s burdens was the hallmark of our nations beginnings • Although caring for one another has been around since the beginning of our country, modern day HCSM were born in the early 1980’s • HCSM has grown and thrived over the past 30+ years as an alternative to traditional health insurance ever rising costs and skyrocketing health care costs • Today nearly 400,000 Americans participate in HCSM and more are joining across America every day (according to www.healthcaresharing.org) Exclusively for Representative Training and Certification use only

28. Membership Qualifications • Application – Process and Procedure • An application can be completed and submitted in person, face to face or electronically on the website • The application has to be submitted with the • First time Application fee - $100 – currently • Altrua Ministries donation - $25 – currently • Payment Methods • ACH – no fees – except if rejected by financial institution • Personal check – returned check fee applicable • Credit Card – 3% fee per transaction • Additional medical records and/or other required documentation must be submitted • The prospective member ‘must’ be advised the application date will be the date all documentation and payment are received by Altrua • Once received and verified as complete, membership will become either full or a membership with limitations tied to the membership type after review of medical and other information provided has been completed Exclusively for Representative Training and Certification use only

29. Membership Qualifications • Application – Process and Procedure • Membership with Limitation means: • The prospective member has (a) specific medical condition(s) which are not eligible for sharing. • The prospective member has the right to decline the membership with limitation • The Application fee - $100 – will be refunded • Altrua Ministry donation - $25 – will not be refunded • Once an application is approved the applicant receives a membership welcome packet with additional information, membership ID cards, and a request for the first monthly contribution. If for any reason an applicant is not accepted into the membership, the membership application fee of $100 is returned to them however, the Altrua Ministry donation of $25.00 is retained by the ministry • Prospective applicants of Altrua are not limited to certain times of the year in which membership is available • If all is in order by the 25th of the month, membership is the 1st of the next month otherwise, the 1st of the following month • Example: • 1-25 May becomes 1st June – 26-31 May becomes 1st July Exclusively for Representative Training and Certification use only

30. Membership Qualifications • Medical History – Overview • Review of automatic decline conditions • Review of Height – Weight – guidelines • Certain medical conditions may result in a pre-existing waiting period or membership limitations • 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 requiring a required additional contribution each month • Active membership can be retroactively declined • A membership limitation and additional contributions tied to such limitations can be adjusted with approved medical evidence Exclusively for Representative Training and Certification use only

31. Membership Qualifications • Dependents - Qualifications • Who qualifies: • Spouse living under the same roof • Newborn of the spouse/mother with appropriate written notification to Altrua within 30 days of birth • Children under the age of 20 • 20 through 24 year old with appropriate documented proof and 90 days beyond 25th birthday with proof of an ongoing need • Full-time student (copy of 12 credit hours per semester) • Full-time service volunteer (copy of call letter needed) • 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 • 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

32. Membership Qualifications • Eligible Needs – Overview • Only needs incurred on or after the membership effective date are eligible for sharing under the membership guidelines • Needs must be filed on appropriate forms and medical records may also be required from providers • Needs arising from a defined and disclosed listing are not eligible • A review of selected circumstances and conditions follows: • Pre-existing conditions will be limited for the first 12 months of membership. Certain limitations may apply for more time dependent on the condition • Lifestyles or activities engaged in after the application date that conflicts the Statement of Standards • Surgery during the first 90 days of membership unless delay could result in health or bodily harm • 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 Exclusively for Representative Training and Certification use only

33. Membership Qualifications • Needs arising from a defined and disclosed listing are not eligible • A review of selected circumstances and conditions follows: • Purchase or rental of durable or reusable equipment or devices (DME), including associated supplies or office visits • Untimely filing of Needs for active members submitted after the Needs are over 9 months old. Needs for inactive members submitted after they are over 6 months. • 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 need unless medically necessary and performed within 15 days • Handling charges, conveyance fees, stat fees, shipping/handling fees, administrative fees, missed appointment fees, telephone/email consultations, additional charges for services in an after-hours setting • Diagnostic testing or cancer diagnosis within first year of effective date ineligible until anniversary date Exclusively for Representative Training and Certification use only

34. 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 Standard and Advantage – Gold and Silver – currently, no limit • Altrua Standard and Advantage – Bronze – currently $50,000 • Membership Responsibility Amounts (MRA) – Eligible needs are limited to the amounts in excess of the MRA, which are applied per individual member per calendar year • MRA(s) – The eligible amount that does not qualify for sharing based on the membership type chosen by the member. • Office Visit MRA – The member will pay a $35 MRA to an affiliated provider and 50% of allowed charges to non-affiliated providers, neither of which applies toward meeting the overall member MRA of the membership type chosen • 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

35. 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 and Activity Limits – Eligible needs arising from any of the following are shared up to a maximum $5000 per need unless otherwise stated • Recreational Limit – Injuries resulting from a recreational vehicle or personal aircraft will be shared up to a maximum of $25,000 if the member submits an additional monthly contribution, as specified and approved by Altrua. • Activity Limit – Injuries resulting from participation in a wide array of activities through school or community programs may be shared up to a maximum of $25,000 if the member submits an additional $300 annual contribution per participant • 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 • Office Visit MRA – The member will submit a $35 MRA to affiliated providers and 50% of allowed charges to non-affiliated providers for each eligible office visit. The $35 MRA will apply to the office visit only with the maximum sharing limit of $300 for Gold and Sliver plans. Any amount that exceeds the $300 maximum will be the responsibility of the member. Exclusively for Representative Training and Certification use only

36. 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 • 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, Medicare/Medicaid, 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. • If a member is 65 years of age or older, this limitation also includes needs that are payable by Medicare A or B, whether the member is enrolled in Medicare or not • 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 • Pre-notification • 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. • Information Booklet Page 25 Exclusively for Representative Training and Certification use only

37. 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 • Pre-notification • ER Visits, Emergency Surgery, Procedure or Test: • Non-emergent use of the emergency room is NOT eligible for sharing. 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 that, if not treated, would lead to further disability or death. • Eligibility for Cancer Needs – In order for needs related to cancer of any type to be eligible, the member must meet the following requirements: • The member is required to contact Altrua within 30 days of the diagnosis. If the member fails at this, the member will be responsible for 50% of the total allowed charges after the MRA(s) has been assessed to the member. • Early detection provides the best chance for successful treatment and in the most cost effective manner. Members age 40 and older are required to receive appropriate screening tests bi-annually, mammograms and gynecological tests for women and PSA testing for men. Failure to do these will render future needs for breast cancer, cervical cancer or prostate cancer ineligible for sharing. Exclusively for Representative Training and Certification use only

38. 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 • Maternity – For a mother who has been a member for 10 consecutive months in a combined membership with a gold or silver membership type prior to conception, 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. • Members participating in a Bronze membership type do not qualify for maternity eligibility • 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. • 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. • If a mother has not been a member as required, needs for maternity will not be eligible for sharing • The newborn will be eligible to participate, 30 days after delivery, subject to the application process • 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 • 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 • Once pregnant the member must notify Altrua to determine eligibility criteria have been met. The member will have the choice of 2 reimbursement options. • Maternity benefits do not apply to adoption Exclusively for Representative Training and Certification use only

39. 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

40. 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

41. The End Exclusively for Representative Training and Certification use only