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ELIGIBILITY CRITERIA FOR THE PROVENA HEALTH FINANCIAL ASSISTANCE PROGRAM

Based upon Federal Poverty Guidelines, Gross income levels 2006

 Family Size 

2006 Federal Poverty Guidelines

 200% Guideline 

 350% Guideline

1

$9,800

$19,600

$34,300

2

$13,200

$26,400

$46,200

3

$16,600

$33,200

$58,100

4

$20,000

$40,000

$70,000

5

$23,400

$46,800

$81,900

6

$26,800

$53,600

$93,800

7

$30,200

$60,400

$105,700

8

$33,600

$67,200

$117,600

9

$37,000

$74,000

$129,500

10

$40,400

$80,800

$141,400

  

CALCULATION PROCESS

  1. Patients who are at or below the 200% guideline will receive a full write-off of charges.
  2. For patients who exceed the 200% guideline, but have income less than the 350% guideline , a sliding scale will be used to determine the percent reduction of charges that will apply.  The matrix for deductions is below:

      DISCOUNT MATRIX

      Percentage of Poverty Guidelines

      Discount Percentage

      Up to 200%

      100%

      201- 225%

      95%

      226 – 250%

      85%

      251 – 275%

      75%

      276 – 300%

      65%

      301 – 325%

      55%

      326 – 350%

      45%