Title: Financial Assistance Policy Document Reference Number: 1226

The principal beneficiaries of the Financial Assistance Policy are intended to be uninsured and underinsured patients who do not qualify for federal, state, or local government assistance, and who are unable to pay for emergency or other medically necessary care. [...] Income and assets will be considered in assessing JMC financial assistance but may not be the sole determining factor. [...] An evaluation of available assets will be necessary to determine eligibility for JMC financial assistance. [...] Size of bill in relation to income and assets may be a qualifying factor in determining financial assistance provided. B. [...] All patients seeking income-based financial assistance at any time in the scheduling or billing process may complete the Financial Assistance Application and will be asked to provide information on Annual Family Income. [...] If JMC determines through third party verification databases that a patient has Annual Family Income at or under 400% of the FPG, that patient will be deemed eligible for financial assistance without further information or documentation at scheduling or prior to admission. 1. [...] Individuals determined by JMC to be eligible for financial assistance under these presumptive eligibility provisions will receive a 100% discount on eligible services.Financial Assistance Policy Continued Page 4 of 6 V. [...] Upon approval of a Financial Assistance Application, the Financial Counselor will submit the adjustment to a Patient Financial Services Manager or designee for entry into the patient accounting system. [...] This may not be a standing approval for future visits. Future visits will require the patient and or guarantor to be re-evaluated. C. [...] Following a determination of eligibility under this FAP, a patient eligible for financial assistance will not be charged more for emergency or other medically necessary care than the AGB to patients who have insurance covering such care.