Introduction

Jefferson Community Health & Life (JCH&L) is committed to providing an exceptional healthcare experience for every person, every time. JCH&L acknowledges the financial needs of patients and families who may be unable to afford the charges associated with the cost of medical care. To manage its resources and responsibilities and to allow JCH&L to provide assistance to the greatest number of patients in need, the Board of Directors has established guidelines for
providing Financial Assistance in accordance with a Financial Assistance Policy.

Eligibility Requirements

In order to be eligible for financial assistance, the patient must qualify as “financially indigent” and the care must be either medically necessary or emergency care. To be “financially indigent”, you must be uninsured or underinsured and have a household income of equal to or less than 300% of Federal Poverty Level. If you are eligible for financial assistance, you will not be charged more than amounts generally billed to patients who have health insurance and will be provided financial assistance based on a sliding fee scale comparing household income to FPL. Please refer to the full policy for a complete explanation and details.

How to Apply

JCH&L encourages patients who may qualify for financial assistance to apply by completing and submitting a financial assistance application to the JCH&L Business Office either in person, by mailing the application to 2200 H Street, Fairbury, NE 68352 Attn: Business Office, or via email to busoff@jchealthandlife.org. Persons applying for financial assistance will not be denied based upon race, color, religion, sex, age, national origin, or marital status. The decision to provide financial assistance will be based on a review of the family’s income as set forth in the application

Where to Obtain Information

Copies of the financial assistance policy, application may be obtained at no charge as follows:

• At the JCH&L admissions desk, emergency department or Business Office at 2200 H Street, Fairbury, NE 68352
• By downloading the information online at www.jchealthandlife.org (under Patient Resources, Patient Financial Information, then click Financial Assistance)
• By calling the JCH&L Business Office at 402-729-3351
• By mailing a request to the following: Business Office, Jefferson Community Health & Life, 2200 H Street, Fairbury, NE 68352
If you have questions about financial assistance or need assistance with applying for financial assistance, you may contact the JCH&L Business Office in person at 2200 H Street, Fairbury, NE 68352 or by calling 402-729-3351 or emailing busoff@jchealthandlife.org.

Translations

JCH&L’s financial assistance policy, financial assistance policy application form, and plain language summary financial assistance policy will be translated for populations with limited English proficiency in accordance with Section 501(r) of the Internal Revenue Code