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ELIGIBILITY CRITERIA FOR THE PROVENA HEALTH FINANCIAL ASSISTANCE PROGRAM

Based upon Federal Poverty Guidelines, Gross income levels 2007

 Family Size 

2007 Federal Poverty Guidelines

 200% Guideline 

 350% Guideline

1

$10,210

$20,420 

$35,735

2

$13,690

$27,380

$47,915

3

$17,170

$34,340

$60,095

4

$20,650

$41,300

$72,275

5

$24,130

$48,260

$84,455

6

$27,610

$55,220

$96,635

7

$31,090

$62,180

$108,815

8

$34,570

$69,140

$120,995

9

$38,050

$76,100

$133,175

10

$41,530

$83,060

 $145,355

  

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%

       

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