Financial assistance

We are committed to providing high quality rehabilitation care and services to our patients. Our hospital provides free or discounted emergency and other medically necessary care to patients who are uninsured or underinsured and who qualify for assistance under its Financial Assistance Policy. Learn about our financial assistance policy and how to apply for assistance.

Financial assistance policy

Purpose

This policy outlines the circumstances under which the hospital will provide free or discounted emergency or other medically necessary care to eligible patients who are unable to pay for their care, as determined by the hospital in accordance with the eligibility criteria and other terms specified in this policy. Patients are expected to cooperate with the hospital’s procedures for obtaining Financial Assistance, securing insurance or other forms of payment, and contributing to the cost of their care based on their ability to pay.

This policy applies to emergency or medically necessary care provided by the hospital. This policy does not apply to care delivered by physicians or other healthcare providers who bill “privately” (separate from the hospital). (See Attachment A for additional information about physicians and other healthcare providers providing care within the hospital.)
 
This policy does not apply to care that is not emergency or medically necessary care, including elective services or items that are solely for the comfort or convenience of a patient.

Financial Assistance does not apply to amounts that are covered by insurance, governmental programs or other funding sources (which may include, but are not limited to, workers’ compensation, automobile or other liability insurance, crime victims’ compensation funds, and litigation recoveries). To be eligible for Financial Assistance, a patient is expected to apply for and comply with all processes related to seeking assistance from other insurers and/or third-party sources of payment (including all applicable governmental programs) as requested by hospital staff. Patients who are noncompliant or uncooperative in attempting to obtain insurance coverage, qualification under governmental programs, or payment from third-party sources will not be eligible for Financial Assistance.
 
A patient will be ineligible for Financial Assistance if the patient, or his or her representative, provides false information or falsified documentation of household size, income, assets, or other pertinent information.

Definitions

Covered Services – emergency or medically necessary care provided by the hospital. Covered Services do not include services that are not emergency or medically necessary care, or care that is provided by physicians or other healthcare providers who bill “privately.”

Emergency or medically necessary care – services that are necessary and appropriate to sustain life or to prevent serious deterioration in the health of the patient from injury or disease. Medically necessary will be determined by the treating physician.

Family – includes spouse/domestic partner, children, and any other persons treated as “dependents” for federal income tax purposes.

Financial Assistance – reduction of an eligible patient’s account balance for Covered Services under the terms of this policy.

Patient – the individual receiving medical treatment and/or, in the case of an unemancipated minor or other dependent, the parent, legal guardian or other person (guarantor) who is financially responsible for the patient.
 
Uninsured – a patient who does not have health insurance coverage, is unable to obtain affordable coverage, and is ineligible for government healthcare programs or other third-party payment sources.
 
Underinsured – a patient who is not uninsured, but whose out-of-pocket medical expenses exceed his or her financial ability to pay.
 
Policy

Subject to the terms of this policy, Financial Assistance is provided to eligible patients who are uninsured 
or underinsured.

Eligibility for Financial Assistance, and the amount of Financial Assistance that will be provided, are based on an individualized assessment by the hospital of a patient’s financial need, generally determined by measuring the patient’s gross family income against the Federal Poverty Guidelines as specified in the Financial Assistance Discount Guidelines in Attachment B, provided that the patient does not have other financial resources that could be used to pay for his or her care. The Financial Assistance Discount Guidelines are adjusted annually to reflect changes in the Federal Poverty Guidelines.

Patients are presumed to be eligible for financial assistance, without completing an application, in the following circumstances:

Homelessness
Deceased with no estate
Mental incapacitation with no one to act on patient’s behalf
Recent Medicaid coverage, i.e. coverage within three (3) months of admission or discharge.

Presumptive financial assistance will be the most generous assistance available under the Financial Assistance Policy.

A patient determined to be eligible for Financial Assistance will not be billed more than the amount generally billed for emergency or other medically necessary care by hospital to individuals who have insurance covering such care. (See Attachment B for additional information about the “amount generally billed” limitation.)

If a patient is underinsured and is determined to be eligible for Financial Assistance, discounts will only apply to the balance due from the patient after insurance payments and other third-party payment sources have been applied to the account.


For purposes of this policy, “income” includes, but is not limited to, revenue from the following sources (before taxes):
 
Wages
Tips
Payments from Social Security
Retirement benefit payments
Unemployment compensation
Worker’s compensation
Veterans’ benefits
Public assistance
Alimony
Child support
Pensions
Regular insurance or annuity payments
Investment income
 
For purposes of this policy, “other financial resources” includes, but is not limited to the following:

Savings
Checking account
Medical savings account, healthcare savings account and/or flexible spending account
Trust fund
Retirement accounts
Investment assets
Other liquid assets
Equity value of real estate, other than the patient’s primary residence
Benefits from charity organizations
Pending litigation
 
To apply for Financial Assistance, a complete Financial Assistance Application is required. A complete Financial Assistance Application is inclusive of, but not limited to, disclosure of household size, employment information, income, assets and other financial resources, outstanding financial obligations, and supporting documents (such as recent tax returns, bank statements and pay stubs), as detailed in the Financial Assistance Application and the associated instructions.  If documentation proving household income is not available, patients may call the hospital finance department at the phone number listed above to discuss other evidence demonstrating eligibility. Undocumented residents (non-U.S. citizens living as residents in the U.S.) and patients who are without a home address may apply for Financial Assistance. Failure to provide the required information and documentation in a timely manner may result in ineligibility for Financial Assistance. 
 
Complete Financial Assistance Applications should be submitted to the hospital at the address listed above. A hospital finance representative will review the application for completeness. Financial Assistance determinations must be approved by the Facility Controller, and in certain circumstances, by the hospital CEO. The hospital will notify patients in writing of the decision on their eligibility under this policy.

Copies of this policy, a plain language summary of this policy, the Financial Assistance Application, and the associated instructions are available free of charge upon request by writing to the address above. These documents can be found in the admitting/registration areas of the hospital and may also be downloaded at hospital’s website.

All patients will be offered a plain language summary of the Financial Assistance Policy during discharge 
or intake. 

Billing statements will contain a written conspicuous notice informing patients about the availability of financial assistance, a telephone number where they may receive more information, as well as website address where the Financial Assistance Policy, application and plain language summary may be found.
 
Further information about this Financial Assistance Policy and assistance with the application process are available by calling Hospital Phone Number, or in person during normal business hours or by appointment from a hospital finance representative.

When a patient does not qualify for Financial Assistance under this policy but has special circumstances, other discounts may be available that are not part of this Financial Assistance Policy.  In these situations, hospital staff will review all available information (including documentation of income, liquid and illiquid assets, and other resources, amount of outstanding medical bills and other financial obligations) and make a case-by-case determination of the patient’s eligibility for other potential discounts.

Once a patient has been discharged and the patient’s balance due has been determined, the Billing Office will mail the patient monthly account statements and make phone calls in an attempt to collect the outstanding balance. If no payment has been received for 120 days, the account may be sent to a third-party collection agency.

The hospital, and any third parties acting on its behalf, do not engage in extraordinary collection actions such as lawsuits, liens, foreclosures, wage garnishment or reporting adverse information to credit agencies.

For additional information, please see the Billing and Collections Policy, which may be downloaded from hospital website. Copies are also available upon request, free of charge, by mail and in admitting/registration areas of the Hospital.
 
Nondiscrimination & emergency medical care

Hospital does not have a dedicated emergency department. The hospital will appraise emergencies, provide initial treatment, and refer or transfer an individual to another hospital/facility, when appropriate, without discrimination and without regard to whether the individual is eligible for Financial Assistance.

Hospital will not engage in actions that discourage individuals from seeking emergency medical care, such as demanding that an individual pay before receiving initial treatment for emergency medical conditions or permitting debt collection activities that interfere with hospital’s appraisal and provision, without discrimination, of such initial treatment.
 

Billing and collections

Amounts charged to a patient eligible for Financial Assistance under this policy will be based on the applicable discount stated in the table above multiplied by the gross charges otherwise billable to the patient, subject to the “AGB” limitation described below.

In accordance with Internal Revenue Code section 501(r), a patient eligible for Financial Assistance under this policy will not be charged more than the amount generally billed to individuals who have insurance covering such care (“AGB”).

Facility has initially elected to calculate AGB under the “prospective Medicare method” described in applicable Treasury Regulations, using the billing and coding process the Facility would use if the individual were a Medicare fee-for-service beneficiary and setting AGB for the care at the amount the Facility determines would be the total amount Medicare would allow for the care (including both the amounts that would be reimbursed by Medicare and the amount the beneficiary would be personally responsible for paying in the form of co-payments, co-insurance, and deductibles).

Financial assistance policy - Plain language summary

Our hospital provides free or discounted emergency and other medically necessary care to patients who are uninsured or underinsured and who qualify for assistance under its Financial Assistance Policy. Assistance does not apply to elective services or items that are solely for the comfort or convenience of a patient. This document is only a summary. Please refer to the Financial Assistance Policy for complete details.

Eligibility Requirements and Assistance Offered Under the Financial Assistance Policy

Patients who qualify for assistance are eligible for income/asset-based, sliding scale discounts for emergency and other medically necessary care. In general:

Patients whose family income is equal to or less than 200% of the Federal Poverty Guidelines are generally eligible for free emergency and medically necessary care. 
Patients whose family income is between 200% and 400% of the Federal Poverty Guidelines are generally eligible for a sliding scale discount ranging from 50% to 75% for emergency and other medically necessary care.

A patient who qualifies for assistance under the Financial Assistance Policy will not be charged more for emergency or medically necessary care than amounts generally billed to patients having insurance covering such care.

How to Obtain Copies of the Financial Assistance Policy and Financial Assistance Application

Copies of the Financial Assistance Policy, this plain language summary, and the Financial Assistance Application and associated instructions are available free of charge upon request by writing to the address above. Copies can also be found in the admitting/registration areas of the hospital. These documents may be found online at the website provided above. Translations of these documents to Spanish are available upon request from our hospital and also may be found online at website address above.  

How to Apply for Assistance Under the Financial Assistance Policy

To apply for financial assistance, please submit a complete Financial Assistance Application with supporting documents to the address above.  

Further information about the Financial Assistance Policy and assistance with the application process are available from the hospital controller via phone number listed above or in person at the address above.

Instructions - financial assistance application

Section A – patient and guarantor information 

Patient Name: Clearly print on the blank line the first name, middle initial, and last name of the patient.
Date: Clearly print on the blank line the date of the application.
Guarantor: Clearly print on the blank line the first name, middle initial, and last name of the patient’s parent, legal guardian or other responsible person (“guarantor”).
Relationship: Clearly print on the blank line the relationship to the patient of the guarantor.
Address: Clearly print on the blank line the address where the patient lives including the city, state and zip.
Phone: Clearly print on the blank line the patient’s phone number.
Patient’s Employer: Clearly print on the blank line the name of the company for which the patient works.
Title: Clearly print on the blank line the job title of the patient.
Years Employed: Clearly print on the blank line the start date of employment.
Spouse’s Name: Clearly print on the blank line the first name, middle initial, and last name of the patient/guarantor’s spouse.
Spouse’s Phone: Clearly print on the blank line the patient’s phone number.
Spouse’s Employer: Clearly print on the blank line the name of the company for which your spouse works.
Title: Clearly print on the blank line the job title of your spouse.
Years Employed: Clearly print on the blank line the start date of employment of your spouse.
Length of Time at Current Residence: Clearly print on the blank line the dates you have lived at the address provided on the application.
Total number of Dependents: Clearly print on the blank line the number of dependents in your household, including yourself. Dependents are those that generally qualify as your dependent for federal income tax purposes.
Health Insurance Provider: Clearly print on the blank line the name of your health insurance carrier (including Medicare, Medicaid or other governmental coverage you may have).
Policy number: Clearly print on the blank line the policy or account number of your insurance policy.

Section B – assets 

Total Household Income: Clearly print the assets of your household (yourself, your spouse, and dependents). You may attach additional sheets of paper if more space is needed. Provide the cash value as well as any loans or obligations you have on that asset

If your household has assets that you do not see listed, please indicate that amount on the line for “Other” and provide a description.
Assets include, but are not limited to savings and checking accounts, medical savings accounts, healthcare savings accounts, flexible spending accounts, trusts, retirement accounts, investment assets, other liquid assets, real estate (other than primary residence), benefits from charity organizations, pending or finalized litigation settlements, etc.
Years Employed: Clearly print on the blank line the start date of employment.
Spouse’s Name: Clearly print on the blank line the first name, middle initial, and last name of the patient/guarantor’s spouse.
Spouse’s Phone: Clearly print on the blank line the patient’s phone number.
Spouse’s Employer: Clearly print on the blank line the name of the company for which your spouse works.
Title: Clearly print on the blank line the job title of your spouse.
Years Employed: Clearly print on the blank line the start date of employment of your spouse.
Length of Time at Current Residence: Clearly print on the blank line the dates you have lived at the address provided on the application.
Total number of Dependents: Clearly print on the blank line the number of dependents in your household, including yourself. Dependents are those that generally qualify as your dependent for federal income tax purposes.
Health Insurance Provider: Clearly print on the blank line the name of your health insurance carrier (including Medicare, Medicaid or other governmental coverage you may have).
Policy number: Clearly print on the blank line the policy or account number of your insurance policy.

Section C – income 
Total Household Income: Clearly print the income your household (yourself, your spouse, and dependents) receives from all sources. You may attach additional sheets of paper if more space is needed. Provide the gross amounts and the amounts received after taxes and other deductions. 

If your household receives income from a source that you do not see listed, please indicate that amount on the line for “Other” and provide a description.
Sources of income include, but are not limited to wages, tips, social security payments, retirement benefits, unemployment, workers’ compensation, veteran benefits, public assistance, alimony, child support, pensions, insurance or annuity contracts, investment income, etc.

Section D – debts and obligations

Total Household Debts and Obligations: Clearly print the debts and obligations of your household (yourself, your spouse, and dependents). You may attach additional sheets of paper if more space is needed. Provide the total amount of the liability and the monthly payment amounts.

If your household has debts or obligations that you do not see listed, please indicate that amount on the line for “Other” and provide a description.
If your household has debts or obligations that are not paid by you every month, take the total amount due during the past 12 months, divide it by 12, and then indicate that amount on the application.
Sources of debts and obligations include, but are not limited to real estate mortgages, household utility bills, telephone, food, automobile loans, charge and credit accounts, other loans, etc.

Section E – required documentation
 
The documents listed in this section are needed to help us determine if you qualify for financial assistance under our Financial Assistance Policy. If you do not have, or cannot produce the items listed, please include an explanation as to why. Please note that additional information or documentation may be requested by a Hospital representative when processing your application.
 
Section F – Certification
 
Patient/Guarantor’s Signature: Carefully read the acknowledgement statement in this section and then sign and date the application.
 


Mailing Instructions/Contact Information 

Submit the completed Financial Assistance Application along with supporting documentation to the hospital’s address. 
   
Further information about the Financial Assistance Policy or assistance with the application process are available from the hospital controller via the hospital phone number, in person at the hospital address or online at the website address. Certain foreign language translations of the Financial Assistance Policy, Plain Language Summary, Financial Assistance Application and Instructions are available upon request. 

Attachment A – Provider-physician listing

Services may be provided in Vanderbilt Stallworth Rehabilitation Hospital by the hospital as well as by other health care practitioners, who may or may not participate with the same health insurers or health maintenance organizations (HMOs) as Vanderbilt Stallworth Rehabilitation Hospital and who may bill you separately. These providers are encouraged, but not required, to follow the financial assistance policy of Vanderbilt Stallworth Rehabilitation Hospital. You should contact the health care practitioner who will provide services to you to determine which health insurers and HMOs the practitioner participates in as a network provider or preferred provider. Contact information for practitioners who may provide services to you during your stay at Vanderbilt Stallworth Rehabilitation Hospital is provided below.

You may request from Vanderbilt Stallworth Rehabilitation Hospital and other health care providers a personalized estimate of reasonably anticipated charges for the treatment of your specific condition.
This listing is updated quarterly and additional providers or physicians may be added and/or presented under an alternate name that may be different from what is listed below.  Please call us directly at 615.320.7600 and ask to speak with Credentialing, so that we can assist you with the most current and accurate information. 

 

 

Ackerly Dana Clay
1918 20th Avenue South Nashville, TN 37212
202-361-2020

Adams Raeanna (Trauma Group) 
1211 21st Ave S, 404 MAB Nashville, TN 37212
615-936-0083

Anderson Sean
2201 Children's Way Nashville, TN 37212
615-322-7578

Azimi Amin
705 N 12th St.Nashville, TN 37206
615-228-3710

Barkley, APN Kassandra
MCN AA 1204Nashville, TN 37232
615-293-2307

Bastas Gerasimos
2201 Children's WayNashville, TN 37232

Berry Kevin
2201 Children's WayNashville, TN 37212
615-322-7578

Bond, III John
2201 MurphyAvenue, #210Nashville, TN 37203
615-327-3443

Brinkley, Jr. Douglas Marshall 
1215 21st Ave S #5209 Nashville, TN 37232
615-322-2318

Brock John

4102 DOT Nashville, TN (9820)
615-936-2228

Brown Nancy D
3100 MCNNashville, TN 37205
615-343-8701

Burgner Anna
1161 21st Ave S, S-3233 MCN Nashville, TN 37232
615-322-6976


Caucci Michael
1601 23rd Avenue SouthNashville, TN 37232
615-327-7000

Cho Sooja
2201 Children's WayNashville, TN 37212
615-322-0738

Cowan Ronald
1601 23rd Ave S, Suite 3057Nashville, TN 37072
615-322-2303

Crocker Kris
4563 Thomasville Road Chapmansboro, TN 37035
615-517-1349
Dennis Bradley
1211 21st Ave S, 404 MAB Nashville, TN 37212
615-936-0083

Donais Kathleen
1211 21st Ave So, MAB 404Nashville, TN 37212
615-936-0083

Durant Tonya
1103 Oxford HouseNashville, TN 37232
615-875-5838

Eastham Shannon
1211 21st Ave S, 404 MABNashville, TN 37212
615-936-0083

Eck Dawn
1313 21st Ave S, 908 Oxford House Nashville, TN 37232
615-936-3500

Fissell Rachel
S-3223 MCNNashville, TN 37232
615-322-6976

Fleisch Sheryl
1103 Oxford House Nashville, TN 37232
615-875-5838 

Gould Edward
1161 21st Ave S, S-3223 MCN Nashville, TN 37232
615-322-6976

Goyal Parul
719 Thompson Lane, Suite 38500 Nashville, TN 37204
615-936-1212

Grogan Eric
1211 Medical Center Dr. Nashville, TN 37232
615-835-5818

Groomes Thomas
2201 Children's WayNashville, TN 37212
615-963-4000

Guillamondegui Oscar
1211 21st Ave S, 404 MABNashville, TN 37212
615-936-0083

Gunter Oliver 
1211 21st Ave S, 404 MABNashville, TN 37212
615-936-0083

Haglund Nicholas
1215 21st Ave S, Room 5209 Nashville, TN 37232
615-936-8187

Hanto Douglas
1313 21st Ave S, 803 Oxford House Nashville, TN 37232
615-936-5369

Hartley Mary Kristen
2201 Children's Way Nashville, TN 37212
615-936-7708

Hayes Rachel
1313 21st Ave S, 908 Oxford House Nashville, TN 37232
615-936-3500

Horton Angela
2201 Children's Way Nashville, TN 37212H
615-310-9730

Huddleston Bart
2201 Children's Way Nashville, TN 37212
615-936-7708

Jacobs Monica
1601 23rd Avenue South. #3031 Nashville, TN 37212
615-343-1514

Johns Jeffery
2201 Children's Way Nashville, TN 37212
615-322-0738

Karp Seth
1301 Medical Center Dr., TVC 3501-A Nashville, TN 37232
615-936-5321

Kearney Michelle
1161 21st Avenue S, MCN AA 1218 Nashville, TN 37232
615-343-1465

Keebler Mary
1215 21st Ave S MCE 5th Fl #5037 Nashville, TN 37232
615-343-3735

Kirshner Howard
A-1116 MCN Nashville, TN (2551)
615-936-0060

Kniery Holly
2201 Children's Way Nashville, TN 37212
615-320-7600

Lambright Eric
1313 21st Avenue S, 609 Oxford HouseNashville, TN 37232
615-831-8189

Madhur Meenakshi
1215 21st Avenue S, MCE Suite 5209Nashville, TN 37232
615-322-2318

Mansourian Vargtez 
2201 Children's WayNashville, TN 37212
615-936-7708

Martus Jeffrey
2200 Children'sWay, 4202 DOT Nashville, TN 37232
615-343-5875

MayAddison
1211 21st Ave S, 404 MAB Nashville, TN 37212
615-936-0083

McClain Lauren
2200 Children's Way, 11208B DOTNashville, TN 37232
615-936-2119

Miller Richard
1211 21st Ave S, 404 MABNashville, TN 37212
615-936-0083

Morgan Sarah
1313 21st Ave S, 908 Oxford House Nashville, TN 37212
615-936-3500

Moses, Jr. Harold

719 ThompsonLane, Suite 24100 Nashville, TN 37204
615-963-4045

Mukherji Bhaskar
2201 Children's Way Nashville,TN 37212
615-322-0738

Myers Cory
1103 Oxford House Nashville, TN 37232
615-875-5838

Nunez Timothy
1211 21st Ave S, 404 MAB Nashville, TN 37212
615-936-0083

Patel Mayur Bipin
1211 21st Ave S, 404 MAB Nashville, TN 37212
615-936-0083

Peetz Allan
1211 21st Ave S, 404 MAB Nashville, TN 37212
615-936-0083

Petracek Michael
1215 21st Ave S, MCE 5025 Nashville, TN 37232
615-343-7363

Pollack Amber
1215 21st Ave S, Suite 5209 Nashville, TN 37232
615-936-1988

Powers James
7155 Medical Center East Nashville, TN (8550)
615-936-3274

Rae Lisa
1211 21st Ave S, 338 MAB Nashville, TN 37212
615-343-6709

Rowe Ama Arthur
1103 Oxford House Nashville, TN 37232
615-875-5838

Schlendorf Kelly
1215 21st Ave S #5209 Nashville, TN 37232
615-936-8187

Schneider Byron
2201 Children's Way Nashville, TN 37212
615-936-7708

Seidner Douglas
514 MAB Nashville, TN 37212
615-322-7959

Smith Sarah

1313 21st Ave S Nashville, TN 37220
615-936-3500

Sriram Subramaniam
VSRH, 2201 CapersAve., Room 1222 Nashville, TN 37212
615-963-4042

Stark, DO Stacy
2201 Children's WayNashville, TN 37212
615-936-5502

Summitt John
3701 The Vanderbilt Clinic Nashville, TN 37232
615-322-2350

Tarvin Emily
6th Floor MCE North Tower 6000 Nashville, TN 37232
615-936-8129

Thompson Callie
1211 21st Ave S, 338 MAB Nashville, TN 37212
615-343-6709

Walker Jessica Nicole
1161 21st Avenue S, MCN AA 1611 Nashville, TN 37232
615-875-7318

Weaver Eleanor
6000 MCE North Tower Nashville, TN 37232
615-936-8219

Whiteman Baker, AG-ACNP Amanda
461 21st Avenue S Nashville, TN 37240
615-936-3013

Wigger Mark
MCE, South Tower, Suite 5209 Campus Zip 8802
615-322-2318

Wilson Amanda
1103 Oxford House Campus Zip 4311
615-343-2630

Wilson Jo Ellen
Vanderbilt Psychiatric Hospital
  
Wright, Jr. John Kelly
801 Oxford House Nashville, TN 37232
615-835-5001

Wyse Ashley
2201 Children's Way Nashville, TN 37212
615-322-0738

Yang Aaron
2201 Children's Way Nashville, TN 37232
615-322-0738

Zalawadiya Sandip
1215 21st Avenue S #5209 Nashville, TN 37232
615-322-2318

Zaman Nusrat
2200 Children's Way Nashville, TN 37212

 

Download the pdf

Attachment B – 2019 Financial Assistance Discount Guidelines

Amounts charged to a patient eligible for Financial Assistance under this policy will be based on the applicable discount stated in the table above multiplied by the gross charges otherwise billable to the patient, subject to the “AGB” limitation described below.

In accordance with Internal Revenue Code section 501(r), a patient eligible for Financial Assistance under this policy will not be charged more than the amount generally billed to individuals who have insurance covering such care (“AGB”).

Facility has initially elected to calculate AGB under the “prospective Medicare method” described in applicable Treasury Regulations, using the billing and coding process the Facility would use if the individual were a Medicare fee-for-service beneficiary and setting AGB for the care at the amount the Facility determines would be the total amount Medicare would allow for the care (including both the amounts that would be reimbursed by Medicare and the amount the beneficiary would be personally responsible for paying in the form of co-payments, co-insurance, and deductibles).

Discount provided 100% discount 75% discount 50% discount
Family size Federal poverty guideline* Income less than or equal to 200% of FPG Income of 201%-300% of FPG Income of 301%-400% of FPG
1 $12,490 $0 - $24,980 $24,981 - $37,470 $37,471 - $48,560
2 $16,910 $0 - $33,820 $33,821 - $50,730 $50,731 - $65,840
3 $21,330 $0 - $42,660 $42,661 - $63,990 $63,991 - $83,120
4 $25,750 $0 - $51,500 $51,501 - $77,250 $77,251 - $100,400
5 $30,170 $0 - $60,340 $60,341 - $90,510 $90,511 - $117,680
6 $34,590 $0 - $69,180 $69,181 - $103,770 $103,771 - $134,960
7 $39,010 $0 - $78,020 $78,021 - $117,030 $117,031 - $152,240
8 $43,430 $0 - $86,860 $86,861 - $130,290 $130,291 - $169,520

* For family units with more than 8 persons, add $4,420 for each additional person.