The County of Santa Clara Health System is committed providing high quality, affordable and accessible health care. While every patient is responsible for the costs of the healthcare services they receive, there may be a program that can help to cover or reduce costs for patients who do not have health insurance or who have high medical costs. Go to “How to Apply” below.
If you are covered by insurance, please know, and fully understand your policy, responsibilities, and insurance benefits. Our Financial Counselors are available to help, but it is your responsibility to understand your benefits and insurance policy. You will also need to provide your insurance information when you come to the hospital and at every clinic visit.
If you have no insurance and do not qualify for a financial assistance program, a deposit will be requested. You will be expected to pay for your healthcare. Payment installment plans are available by cash, check, Visa, or MasterCard. You may also qualify for a discount for prompt payment of your medical bills.
If you have applied for a program, the program will be billed for regular charges. Depending on the program, you may be responsible for co-pays, deductibles, or share-of-costs that the program does not cover.
How to Apply for Financial Help
Our staff can help you apply for a program. You will need to fill out an application and provide all the required documents. The information you provide will determine which program you may qualify for.
STEP 1: COMPLETE A FINANCIAL ASSISTANCE APPLICATION
Applications must be complete to be processed and all the required documents must be completed. Applications that are not finished and/or do not have all the documents will not be processed..
STEP 2: PROVIDE ALL REQUIRED DOCUMENTS
You will need to provide copies of the documents in the Document Checklist with your application. Documents include:
- Proof of identity
- Proof of Santa Clara County residency
- Proof of income
When you have all your documents, attach them to your completed application and turn them in.
STEP 3: GET ALL INFORMATION TO THE PATIENT ACCESS DEPARTMENT
Completed applications with all the required documents can be faxed to 408-494-7848, or scanned and e-mailed to [email protected]. They can also be delivered in person to Patient Access Department, 770 S. Bascom Avenue San José, CA.
The information will be reviewed according to the rules for each program or agency. The staff uses these rules to determine if you are eligible for a state program, a county program, a discount, or full financial assistance.
To complete your Financial Assistance Application, please review this checklist.
Provide copies of the following documents:
- Proof of Residency in Santa Clara County – Provide ONE of the following:
- Rental Contract/Lease
- Mortgage Statement
- Utility Bill (Water, Electric Gas, Garbage)
- Homeless (Completion of patient statement form)
- Vehicle Registration
- Driver License (Current)
- Letter of support from person with whom applicant is living and proof of residency for that person
- Proof of Identity (Photo ID Required) – Provide ONE of the following:
- Driver’s License
- Government-issued ID Card
- Work or School ID Card
- Birth Certificate along with any identification (such as gym/Costco)
- Proof of Income – Provide ALL that Apply:
- Check Stubs (all stubs not older than 45 days from application date)
- Tax Return (current tax year)
- Award Letter (Social Security, Disability, Unemployment, Worker’s Compensation)
- Cash Income Statements (including tips)
- Military Benefits Statement
- Rental Income Receipts
If required – these documents must be originals:
- Eligibility for some programs requires that a person provides proof of U.S. Citizenship or U.S. Permanent Residency. If you are eligible for a program that requires proof of citizenship or permanent residency, you will be instructed to bring original documents. Copies will not be accepted. Undocumented individuals may be eligible for programs that do not require proof of U.S. Citizenship or U.S. Permanent Residency.
- Depending on a person’s declarations and/or differences in documentation, additional documents may be required. If more documents are required, you will be instructed which documents to provide. You will also be given a deadline for returning additional documents to the Patient Access Department.
Financial Assistance Programs
The County of Santa Clara Health System is committed to ensuring residents understand what health care options are available.
This state program serves low-income individuals including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.
Covered California and the Affordable Care Act
Covered CA is the health insurance marketplace started under the federal Affordable Care Act (ACA). Covered CA helps eligible individuals and small businesses purchase private health insurance coverage at federally subsidized rates. The ACA, also known as Obamacare, means more people have access to affordable health insurance. You can go to www.coveredca.com for more information about Covered California plans and apply online.
Healthcare Access Program
This program reduces the amount you owe for services and/or medicines based on your income. For some people there will be no cost. Our team will assist you in completing an application and turning in any documents needed to determine if you are eligible. The information you share will be kept confidential and will only be used for providing you care.
Interest-Free Payment Plans
If you have difficulty paying your bill, our staff can help set up long-term interest-free payment plans.
Prompt Pay Patient Discount
If you do not have health insurance coverage and do not receive assistance under any of the programs listed above, ask about this program. The program offers a discount on the amount due if it is paid within thirty days of getting your bill.