NICTC will provide necessary health care services within the scope of its mission and capabilities to all persons, regardless of their ability to pay. It is the policy of NICTC that those without an ability to pay will be evaluated as to eligibility for charity under the following guidelines.
Charity care is generally secondary to all other financial resources available to the patient including insurance, government programs, third party liability and liquid assets.
Full charity care will be provided to a responsible party with gross family income at or below 200% of published Federal Poverty Income Guidelines. You must be applying to Illinois Medicaid or have applied in the past to be considered.
A sliding fee schedule (Attachment A) will be used to determine charity discounts when gross family income is over 100% of Federal Poverty Income Guidelines. Available liquid assets, proportionate to verified income, will also be considered.
Charity care may be provided to a responsible party with gross family income greater than 200% of the Federal Poverty Income Guidelines, if circumstances such as extraordinary, non-discretionary expenses, future earning capacity and the ability to make payments over an extended period of time warrant consideration.
Reasonable payment arrangements, consistent with the eligible responsible party's ability to make payments, will be extended for amounts not discounted under the Charity Matrix. NICTC reserves the right to revoke charity discounts and assign all unpaid balances to collections if an extended payment agreement is in default.
Charity care does not apply retroactively. It only applies for current of or future services. Charity care applications are effective for six months.
Charity care will not be provided to those whose exhibited expenses are greater than twice the level of poverty per family unit on the current Health and Human Services Poverty Guidelines.
Requests for consideration may be proposed by sources such as physician, community or religious groups, social services, hospital personnel, the patient, guarantor or family member. NICTC will use an application process for determining initial interest in and qualification for charity care. Responsible party's not choosing to apply for charity care will not be considered unless sufficient information is available to make a final determination without his/her application. NICTC's decision to provide charity care in no way effects the responsible party's obligations to their physician or other healthcare providers.
NICTC will not initiate collection efforts or requests for payments while the application is in process. Following the initial request, NICTC may pursue other sources of funding, including Medicaid.
NICTC will furnish an application and instructions to the responsible party when charity care is requested, or when financial screening indicates potential need.
The responsible party must return a completed application within 10 working days. It will be made in writing and accompanied by sufficient documentation to verify income amounts indicated on the application form for the 12 months prior to the date of request.
Required forms of income verification include: payroll stubs, IRS tax returns from the most recently filed calendar year, determination of eligibility for unemployment compensation, attestation of absence of income from the responsible party or letter of support from individuals providing basic needs.
NICTC will keep confidential all information on the application and supporting documentation. NICTC, at its own expense, may request a credit report to further verify the information on the application. An incomplete or fraudulent application will be denied as will any application not returned to NICTC within 10 working days of receipt of the application by the responsible party.
NICTC will return to the responsible party written notification of eligibility for charity care within 14 working days of receipt of a complete application from the responsible party. This notification will include the level of reduction. Denials will include the reason for denial.
Revised February 3, 2014