Financial Assistance

How to Apply

Traditional Christian Care Program
To apply for the Traditional program you must provide the following:
1. Completed Application Form
2. Copies of earning statements for the past three months.
3. Copies of your Federal Income Tax Return for the most recent year.
4. Copies of your bank statements for the past three months.
5. Proof of either an approval or denial from the Illinois Department of Public Aid for Medicaid Assistance.

To qualify for the Traditional Christian Care Program your family income must be less than 200% of the FPG as listed below.

Family Size	Income
1 2 3 4 5 6 7 8	$ 20,420 $ 27,380 $ 34,340 $ 41,300 $ 48,260 $ 55,220 $ 62,180 $ 69,140

For those persons qualifying for this program, a discount ranging from 25% to 100% may be given.

All requested information must be received and completed to be considered for any of the hospital's programs. A hospital representative will contact you either in writing or by telephone should they have questions or need additional information.

Where to send your completed application:
Business Office Manager
St. Joseph's Hospital
9515 Holy Cross Lane
PO Box 99
Breese, Illinois 62230

Traditional Christian Care
If you are determined eligible...

You will be notified on your next billing statement by a discount or allowance given on your account, and the amount of assistance granted.
The designated amount will be subtracted from your next billing statement.
Alternative financial arrangements to pay any remaining balance should be made within 30 days, or special payment arrangements may be made by contacting the Business Office.

If you are determined ineligible....

You will be notified in writing of your eligibility.
You should contact the Business Office to establish payment arrangements within ten (10) days from the date of notification of ineligibility.

Information on Uninsured Discount Programs