Financial Assistance Policy Plain Language Summary

How Do I Qualify for Financial Assistance?

You can ask for help with your bill at any time during your visit or billing process. We will determine how much you owe

by reviewing income, assets, or other resources. If your yearly income is less than or equal to 300% of the current
Federal poverty Guideline, you may not have to pay your bill. Federal Poverty Guidelinescan be found at:
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines

You may qualify for assistance with all or part of your bill, the help is based on a sliding scale that considers your yearly income and family size.

How Can I Apply for Financial Assistance?

Toobtain a free copy of theFinancialAssistanceApplication, or Financial Assistance policy you have several options. 1) Go tohttp://www.hnjh.org

2) In person atone of these addresses:502 W Harrie St Newberry MI,

                                                                        W14034 Melville Rd, Engadine MI

                                                                        W17530 Main St Curtis MI,

                                                                        32040 W M28 Eckerman MI.

3) By mail, send us a letter at 502 W Harrie St, Newberry, MI 49868, Attn: Patient account office.

4) By phone, call 906-293-9123 or 906-293-9115.

5) By email: ptaccounts@hnjh.org

How long is my application good for?

Account balance that are eligible for a discount are applied up to180 days(6months)prior to when the application is
received and up to180 (6 Months) days afterthe application is received

Paperwork

You are responsible for providing information timely about your health benefits, income, assets, and any other

paperwork that will help tosee if you qualify. Paperwork might be bank statements, income tax forms, check stubs or
other information.

Covered Services

Hospital services or care renderedto a patient, both In-Patient and Out-Patient, in order to diagnose, alleviate, correct,

cure, or prevent the ones or worsening of conditions that endanger handicap, or result in overall illness or infirmity.