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Charity
Care Program at
Saint Michael’s Medical Center
The Charity Care program is designed to help you with
your hospital bills. Eligibility is based upon your income and assets
on the day you receive treatment. The program does not cover physician
fees. The documents listed below may be requested to complete your Charity
Care Application:
- Pay stubs or a letter from your employer on letterhead
providing a breakdown of your gross salary (pay stubs for one month,
thirteen weeks, or 52 weeks prior to date[s] of service)
- A Social Security benefit letter (covering date[s]
of service)
- A copy of your checking/savings account statement
(covering date[s] of service)
- Personal Identification documents
- A Welfare benefit letter (covering date[s] of service)
- Pension, IRA, Mutual Fund, or Stock documentation
(covering date[s] of service)
- Proof of N.J. residency (prior to date[s] of service)
Be sure you have read and understood the income
and asset criteria listed on the application.
To apply for the Charity Care program, download
and complete the forms provided below. Your completed application should
be mailed to:
Saint Michael’s Medical Center
Attn: Charity Care Department
Building C, 3rd Floor
111 Central Ave
Newark, New Jersey 07102
For additional assistance, please contact us, at (973)
877-5195, (973) 877-2709, or (973) 877-2467.
FORMS
Use the free Adobe
Acrobat Reader to view and print the forms listed below.
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