Southwest General Hospital

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Financial Assistance

Southwest General Health Center is required to provide emergent medically necessary healthcare
without charge to persons who cannot afford to pay for care.

You are eligible for medically necessary healthcare at no cost to you if your family income does not
exceed the Federal Poverty Income Guidelines.

You may be eligible for medically necessary healthcare at reduced cost to you if your family income
does not exceed 400% of the Federal Poverty Income Guidelines.

FINANCIAL ASSISTANCE 2016

Family Size 100% Federal
Poverty Guidelines
101 - 250% Federal
Poverty Guidelines
251 – 400% Federal
Poverty Guidelines
1 $11,880 $29,700 $47,520
2 $16,020 $40,050 $64,080
3 $20,160 $50,400 $80,640
4 $24,300 $60,750 $97,200
5 $28,440 $71,100 $113,760
6 $32,580 $81,450 $130,320
7 $36,730 $91,825 $146,920
8 $40,890 $102,225 $163,560
9 $45,050 $112,625 $180,200
10 $49,210 $123,025 $196,840
Additional Family
Members
$4,160 $10,400 $16,640
Then 100% Discount 100% Discount Medicare Rates


The definition of “family” shall include the parent(s), their spouse, and all their children, natural or adoptive, under the age of eighteen who live in the home.

If it appears that you may be eligible for assistance from Federal or State agencies, you are required to apply to these agencies before your request for financial assistance is finalized.

If you think you may be eligible for financial assistance, please complete the application form (link to form located in the left navigation links) and send it with income verification to the address listed on the form. A copy of your written determination will be sent to you.

Southwest General Health Center offers other programs to assist with medically necessary services.

Should you have any questions, please contact customer service at:
844-530-1996 weekdays 8:00 a.m. – 7:00 p.m.

OR

Financial Clearance at:
440-816-4701 weekdays 8:00 a.m – 4:30 p.m.