CARLE EUREKA HOSPITAL

"Total income of the people living in the home is used to determine if you will get assistance. If this income is below 200% of the Federal Poverty Level (FPL), you will not have to pay your hospital bill."

documented · checked 2026-10-10 · [PDF] PLAIN LANGUAGE SUMMARY OF CARLE HEALTH FINANCIAL ...

"| **Family Size** | 200% | 300% | 400% | 600% | | --- | --- | --- | --- | --- | | 1 | $31,920 | $47,880 | $63,840 | $95,760 | | 2 | $43,280 | $64,920 | $86,560 | $129,840 | | 3 | $54,640 | $81,960 | $109,280 | $163,920 | | 4 | $66,000 | $99,000 | $132,000 | $198,000 | | 5 | $77,360 | $116,040 | $154,720 | $232,080 | | 6 | $88,720 | $133,080 | $177,440 | $266,160 | | 7 | $100,080 | $150,120 | $200,160 | $300,240 | | 8 | $111,440 | $167,160 | $222,880 | $334,320 | | Add per Each Additional Person | $11,360 | $17,040 | $22,720 | $34,080 | | Program Eligibility | 100% Financial Assistance | 50% Financial Assistance and Illinois Hospital Uninsured Discount Program Max | CAP 40% of income | Illinois Hospital Uninsured Patient Discount Program Max |"

documented · checked 2026-10-10 · **carle.org/FinancialAssistance**

"Required 1. Copy of your most recent Federal Tax Return that you filed or were claimed as a dependent on. 2. Copy of most recent pay stubs for all employed family members for current and prior year, showing year-to-date gross income. 3. Copy of self-employment income and expenses for the current and prior year. 4. Copy of Social Security or Social Security Disability award letter for the current and prior year. 5. Copy of Unemployment statement, Disability award, or Workers Compensation award. 6. Copy of Medical Flexible Spending Account or Health Spending Account funds available. 7. Other income source documentation (i.e. child support, alimony, retirement income and/or letter from employer - if paid in cash) 8. Medicare Part A or Part B beneficiaries must also provide current bank statements from any checking, savings or investment accounts. 9. Written statement if cannot supply the above required documents. ASSET VERIFICATION Documentation and proof of assets: - Checking and savings accounts statements - Investments: certificate of deposit (CD), mutual funds, stocks and bonds statements"

documented · checked 2026-10-10 · Financial Assistance Programs - Carle Foundation Hospital

"Please complete this application and submit to any Carle location in person, by mail, by electronic mail, or by fax to apply for assistance within 90 days following the date of discharge or receipt of services."

documented · checked 2026-10-10 · Financial Assistance Programs - Carle Foundation Hospital

"Phone: (888) 712-2753"

documented · checked 2026-10-10 · Financial Assistance Programs - Carle Foundation Hospital

"Availability of Translations The Financial Assistance policy, application form, and the plain language summary is offered in the following languages: English, Spanish and French."

documented · checked 2026-10-10 · [PDF] PLAIN LANGUAGE SUMMARY OF CARLE HEALTH FINANCIAL ...

"Carle Eureka Hospital and Clinic Locations: • Carle Eureka • Carle El Paso"

documented · checked 2026-10-10 · Carle Financial Assistance Programs