Charity-Care_FPL_051010_2010 by mudoc123

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									                      KINGSBROOK JEWISH MEDICAL CENTER
       FINANCIAL ASSISTANCE / SLIDING SCALE QUALIFICATION GUIDELINES
Revised for March 2010
     Family            100 % Federal                 200%         225%           250%         275%           300%
      Size                 Level                       A             B             C             D             E

                  1             $10,830              $21,660       $24,368       $27,075      $29,783        $32,490

                  2             $14,570              $29,140       $32,783       $36,425      $40,068        $43,710

                  3             $18,310              $36,620       $41,198       $45,775      $50,353        $54,930

                  4             $22,050              $44,100       $49,613       $55,125      $60,638        $66,150

                  5             $25,790              $51,580       $58,028       $64,475      $70,923        $77,370

                  6             $29,530              $59,060       $66,443       $73,825      $81,208        $88,590

                  7             $33,270              $66,540       $74,858       $83,175      $91,493        $99,810

               8           $37,010         $74,020                 $83,273       $92,525 $101,778 $111,030
For each additional person, add $3,740.00.

                       POVERTY LEVEL                           PATIENT RESPONSIBILITY
A                     LESS THAN                        200%    0% OF CHARGES
B                              200% TO                 225%    20% OF CHARGES
C                              225% TO                 250%    40% OF CHARGES
D                              250% TO                 275%    60% OF CHARGES
E                              275% TO                 300%    80% OF CHARGES
                               OVER                    300%    100% OF CHARGES

CLINIC                HOSPITAL                                    SLIDING SCALE FEE
VISIT                 CHARGE                           Excludes the NYS HCRA Surcharge of 9.63%
                                                 A          B           C        D         E
LEVEL 1                        $137.00                $0.00     $27.40    $54.80   $82.20 $109.60
LEVEL 2                        $149.00                $0.00     $29.80    $59.60   $89.40 $119.20
LEVEL 3                        $159.00                $0.00     $31.80    $63.60   $95.40 $127.20
LEVEL 4                        $202.00                $0.00     $40.40    $80.80 $121.20 $161.60
LEVEL 5                        $444.00                $0.00     $88.80 $177.60 $266.40 $355.20

Kingsbrook Jewish Medical Center's Financial Assistance Program is based upon up to 300% of the March 2010
Department of Health & Human Services Federal Poverty Guidelines.
                 KINGSBROOK JEWISH MEDICAL CENTER
    FINANCIAL ASSISTANCE / SLIDING SCALE QUALIFICATION GUIDELINES
Revised for January 2007
 Family        100 % Federal              200%           225%       250%         275%            300%
  Size             Level                    A               B         C             D              E

           1           10,210             20,420         22,973      25,525       28,078            30,630

           2           13,690             27,380         30,803      34,225       37,648            41,070

           3           17,170             34,340         38,633      42,925       47,218            51,510

           4           20,650             41,300         46,463      51,625       56,788            61,950

           5           24,130             48,260         54,293      60,325       66,358            72,390

           6           27,610             55,220         62,123      69,025       75,928            82,830

           7           31,090             62,180         69,953      77,725       85,498            93,270

         8          34,570          69,140               77,783      86,425       95,068          103,710
For each additional person, add $3,480.00.

                 POVERTY LEVEL                       PATIENT RESPONSIBILITY

A              LESS THAN                   200%      0% OF CHARGES
B                     200%       TO        225%      20% OF CHARGES
C                     225%       TO        250%      40% OF CHARGES
D                     250%       TO        275%      60% OF CHARGES
E                     275%       TO        300%      80% OF CHARGES
               OVER                        300%      100% OF CHARGES

CLINIC         HOSPITAL                                        SLIDING SCALE
VISIT          CHARGE                                               FEE
                                      A              B          C         D        E
LEVEL 1                 90.00                    0        18.00     36.00    54.00                   72.00
LEVEL 2                 97.00                    0        19.40     38.80    58.20                   77.60
LEVEL 3                104.00                    0        20.80     41.60    62.40                   83.20
LEVEL 4                114.00                    0        22.80     45.60    68.40                   91.20
LEVEL 5                297.00                    0        59.40    118.80   178.20                  237.60

Kingsbrook Jewish Medical Center's Financial Assistance Program is based upon up to 300% of the January 2007
Department of Health & Human Services Federal Poverty Guidelines.

								
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