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    Financial Assistance Guidelines

    Qualification for Financial Assistance is based upon a full review of your documentation when returned with your Financial Assistance Application.
    The following chart with 2012 statistics represents only one of the criteria used to evaluate the patient for assistance. See also current year HHS Poverty GuidelinesOpens new window.

    Family SizeFederal Poverty Guidelines (100%) Period-AnnualFederal Poverty Guidelines (100%) Period-MonthlyIf income is below 400% (shown below) of FPIG, eligible for Full write-off Period-AnnualIf income is below 400% (shown below) of FPIG, eligible for Full write-off Period-Monthly
    1$11,170$930.84$44,680$3,723.36
    2$15,130$1,260.84$60,520$5,043.36
    3$19,090$1,590.84$76,360$6,363.36
    4$23,050$1,920.84$92,200$7,683.36
    5$27,010$2,250.84$108,040$9,003.36
    6$30,970$2,580.84$123,880$10,323.36
    7$34,930$2,910.84$139,720$11,643.36
    8$38,890$3,240.84$155,560$12,963.36
    For each additional person, add:$3,960$330$15,840$1320