How To Apply
To apply for either uninsured 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. Statement of Assets
5. Copies of Last Three (3) months bank statements
If you are uninsured - you will qualify for one of the Financial Assistance Programs. The discount you receive will be determined upon receipt and review of your fully completed application form and required attachments.
If your income is less than the income listed below you will be entitled to a 45% Uninsured Christian Care Discount.
If your family income is greater than the income listed below you will be entitled to an 10% Uninsured Discount Program .
Family Size |
Income |
1 2 3 4 5 6 7 8 |
$ 64,980 $ 87,420 $ 109,860 $ 132,300 $ 154,740 $ 177,180 $ 199,620 $ 222,060 |
Where to send your completed application:
Business Office Manager
St. Joseph's Hospital
9515 Holy Cross Lane
PO Box 99
Breese, Illinois 62230
Uninsured Financial Assistance Program
|
Information on Traditional Christian Care Program
