{"hospital":{"ccn":"310073","name":"JERSEY SHORE UNIVERSITY MEDICAL CENTER","city":"NEPTUNE","state":"NJ","zip":"07754","phone":"732-775-5500","ownership":"Voluntary non-profit - Private","website_domain":"hackensackmeridianhealth.org","system":null},"version":3,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"| less than or equal to 200% | 0%","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Compassionate Care III: Insured patients with income levels at or below 600% of the Federal Poverty Level (FPL) may be eligible for a 50% discount on cost-share amounts.","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":null,"state_programs":null},"apply":{"form_url":{"value":"https://www.hackensackmeridianhealth.org/en/pay-bill/financial-assistance","layer":"documented","quote":"Application Form: The Charity Care application form is included as Appendix A to this policy. It can also be found at this url: <https://www.hackensackmeridianhealth.org/en/pay-bill/financial-assistance>","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"form_version":null,"documents_required":{"value":["photo_id","proof_of_income","social_security_letter","tax_return","pay_stubs","bank_statements","proof_of_residency","insurance_card"],"layer":"documented","quote":"Personal ID for patient, spouse, children under 18, and full time college students 21 and under ● Choose one for each member of your family: driver’s license, birth certificate, Social Security card, passport Insurance Cards ● Copy the front and back of insurance card Banking/Asset statements that include the balance on your date of service ● Checking, savings, and debit card account statements ● Deposits over your reported income may require an explanation ● Current documentation for any CD’s, IRA’s, 401K’s, stocks or bonds Proof of Income for the one month prior to the date of service ● Proof of earned income, including pay stubs or a written signed statement of gross earnings from your employer on business letterhead ● If you are self-employed, a profit and loss statement signed by an accountant is required along with a copy of the tax return for the prior year. If your business is a partnership or corporation, provide a letter from an accountant with your weekly salary draw.\n● Proof of unearned income, including but not limited to retirement pension, child support, alimony, VA benefits, Social Security award letter, SSI Award letters for all family members, unemployment or State Disability record or other financial contributions Proof of Residence prior to the date of service ● Must show street address – NOT a PO Box ● Please choose one of the following: driver’s license, copy of lease, utility bill, dated mail with your name and address issued prior to date of service","source_id":"application-380fb7000baf628d","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":null,"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Application Period: The applicant has up to one year from the date of service to apply for hospital assistance and provide the hospital with a completed application. At minimum, patients will be allowed 240 days from the first post-discharge billing statement to apply for Charity Care.","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"732-902-7080","layer":"documented","quote":"By Phone: The Financial Assistance Department can be reached at [732-902-7080](tel:17329027080).","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"hours":{"value":"Monday through Friday, 8:00 AM-4:00 PM","layer":"documented","quote":"By stopping by the Financial Assistance Department in person (Monday through Friday, 8:00 AM-4:00 PM)","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"languages":{"value":["English"],"layer":"documented","quote":"The HMH Financial Assistance Application and Plain Language Summary (“PLS”) are available in English and in the primary language of populations with limited proficiency in English (“LEP”) that constitute the lesser of 1,000 individuals or 5% of hospital’s primary service area.","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0}},"coverage":{"facilities":{"value":["Jersey Shore University Medical Center"],"layer":"documented","quote":"Jersey Shore University Medical Center","source_id":"fap-1062f2d2e0bb0f9b","checked_on":"2026-10-13","confidence":1.0,"support_count":0},"provider_list_url":null},"sources":[{"id":"fap-1062f2d2e0bb0f9b","kind":"hospital_web","url":"https://hackensackmeridianhealth.org/en/pay-bill/financial-assistance/financial-assistance-policy","title":"Financial Assistance Information | Hackensack Meridian Health","fetched_on":"2026-10-13","sha256":"1062f2d2e0bb0f9b7b8f577c478d2d72f636215cf003480cf1a1a907f360ab1d","effective_date":null},{"id":"application-380fb7000baf628d","kind":"hospital_web","url":"https://www.hackensackmeridianhealth.org/-/media/Project/HMH/HMH/shared/Files/Financial-Assistance-Languages/Charity-Care-Applications/Charity-Care-Application-English.pdf","title":"Charity Care/Financial Assistance Application Process","fetched_on":"2026-10-13","sha256":"380fb7000baf628db2bba39b441067be87c9140e8c8e290cbdc337a20f66baa4","effective_date":null},{"id":"summary-3f5dc56b645ce1cb","kind":"hospital_web","url":"https://hackensackmeridianhealth.org/en/pay-bill/financial-assistance/financial-assistance-policy-plain-language","title":"Financial Assistance for Healthcare | Hackensack Meridian Health","fetched_on":"2026-10-13","sha256":"3f5dc56b645ce1cb2f3dd58fc6121b922a53d8b37023e5ca5a8ed21d0c7feded","effective_date":null},{"id":"billing-938a8d6419431fba","kind":"hospital_web","url":"https://hackensackmeridianhealth.org/en/pay-bill/financial-assistance","title":"Financial Assistance | Hospital Billing Help | Hackensack Meridian Health","fetched_on":"2026-10-13","sha256":"938a8d6419431fba79a2e7e984c36a1b1eb66f54d406a788eef7700124c26c4f","effective_date":null},{"id":"fap-eaa800e45c5445fe","kind":"hospital_web","url":"https://www.hackensackmeridianhealth.org/-/media/project/hmh/hmh/public/pdfs/nj-charity-care-fact-sheet-january-2026-spanish.pdf","title":"Spanish (PDF)","fetched_on":"2026-10-13","sha256":"eaa800e45c5445fe3c02d588780e688c6fdb1642596a371dd84ee2dfa0fcf09a","effective_date":null},{"id":"application-9555a7c5af19c467","kind":"hospital_web","url":"https://www.hackensackmeridianhealth.org/-/media/project/hmh/hmh/public/pay-bill/charity-care-application-2026.pdf","title":"Charity Care Application","fetched_on":"2026-10-13","sha256":"9555a7c5af19c4673c0828c283d85a375d8802d2eda715ba70a13de01a7ebbb9","effective_date":null},{"id":"application-11f198000ab56f6d","kind":"hospital_web","url":"https://www.hackensackmeridianhealth.org/-/media/project/hmh/hmh/shared/files/financial-assistance-languages/charity-care-applications/20220623/charity_care_application_arabic_5_31_22_ar_final.pdf?sc_lang=en&hash=01437DDE70439C183E2B3E7EA121F041","title":"Arabic","fetched_on":"2026-10-13","sha256":"11f198000ab56f6dbac703b46bfaf871e4f8d987388910c7e77c6495dd4691dc","effective_date":null}],"accuracy":null}