1. At your first visit, you will be filling out an application form
New patients will meet with our Help Team to review the Healthy Neighbor Plan application. Household members considered a part of the household may include: Members of the guarantor’s household, other family members dependent on the guarantor for support, such as children the guarantor supports, but does not have physical custody of, significant others living with the guarantor, but not legally related, household members over the age of 18 must include the guarantor on the verbal communication document for financial information.
All reported members must use a single guarantor to be considered a household member and the guarantor agrees to be financially responsible for member’s healthcare balances.
2. You will be asked to provide proof of income (any of the following)
Please bring your proof of income statements to your first appointment.
- Latest IRS 1040 form OR
- 3 months of income pay stubs OR
- Bank statements showing income deposits
Income includes: earnings, unemployment compensation, workers' compensation, Social Security, Supplemental Security Income, public assistance, veterans' payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources.