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OHIOHEALTH SHELBY HOSPITAL

SHELBY, OH · version 1 · published · JSON

eligibility.free_care_max_fpl200% of the federal poverty level

"• a 100% discount off of the patient’s payment responsibility to patients whose income is at or below 200% of the Federal Poverty Guidelines;"

documented · checked 2026-10-14 · OhioHealth Financial Assistance Policy

eligibility.discount_tiersAbove 200% up to 300% of FPL: 80% discount
Above 300% up to 400% of FPL: 65% discount

"The OhioHealth Charity Program will provide: • a 100% discount off of the patient’s payment responsibility to patients whose income is at or below 200% of the Federal Poverty Guidelines; • a 80% discount off of the patient’s payment responsibility to patients whose income is at or below 300% of the Federal Poverty Guidelines; or • a 65% discount off the patient’s payment responsibility to patients whose income is at or below 400% of the Federal Poverty Guidelines."

documented · checked 2026-10-14 · OhioHealth Financial Assistance Policy

apply.documents_requiredProof of income

"If you wrote $0.00 for income, provide an explanation of how you were being supported Explain your means of support (including the names and phone numbers of the individual(s) supporting you) since there was $0.00 income for 3 months prior to the date of service or date of application."

documented · checked 2026-10-14 · Tips for Completing the Financial Assistance Application

apply.submit_methodsMail: mail your application along with income documentation to: OhioHealth L-4312 Columbus, OH 43260
Fax: fax to 614-566-6080

"To apply, complete the application on the reverse side and fax to 614-566-6080 or mail your application along with income documentation to: OhioHealth L-4312 Columbus, OH 43260"

documented · checked 2026-10-14 · Tips for Completing the Financial Assistance Application

Sources

Xeerka Caawinta Dhaqaalaha (“FAP”) — fetched 2026-10-14

Tips for Completing the Financial Assistance Application — fetched 2026-10-14

OhioHealth Financial Assistance Policy for Medical Needs — fetched 2026-10-14

OhioHealth | Financial Assistance and Charity Care — fetched 2026-10-14

OhioHealth Financial Assistance Policy — fetched 2026-10-14

List of Specialities — fetched 2026-10-14

HCAP Charity Worksheet — fetched 2026-10-14

Financial Assistance Policy — fetched 2026-10-14