Financial Assistance Policy

Financial Assistance Policy (Medical)

Eligible Individuals

Patients receiving urgent or medically necessary care who submit a Financial Assistance Application (including required documentation), and who are determined eligible for Financial Assistance by Penn Highlands Healthcare.

Eligible Services

Eligible services are emergent and/or medically necessary healthcare services provided by Penn Highlands Healthcare (PHH), which includes Brookville, Connellsville, Clearfield, DuBois, Elk, Huntingdon, Mon Valley, State College and Tyrone facilities, Penn Highlands Healthcare at Home and the Penn Highlands Physician Network (PHPN).

Determination of Financial Assistance (Medical) Eligibility

Generally, individuals are eligible for financial assistance based upon their income level according to the federal poverty guidelines and their ability to pay.

• Individuals with a family income of 100-200% percent of the federal poverty guidelines or less may be eligible for a discount of 100 percent.
• Individuals with a family income of 201-250 percent of the federal poverty guidelines may be eligible for a discount of 80 percent.
• Individuals with a family income of 251-300 percent of the federal poverty guidelines may be eligible for a discount of 65 percent.

Eligible individuals will not be charged more for emergency or other medically necessary care than Amounts Generally Billed, or AGB, to individuals with insurance.

Financial assistance is not available for individuals who opt out of available insurance coverage, or those who fail to reasonably comply with insurance requirements, such as obtaining authorizations or referrals.

How to Apply

Financial Assistance Applications may be obtained and/or submitted as follows:

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Penn Highlands Pharmacy Financial Assistance Policy

Eligible Individuals

Patients with insurance who have a prescription written by a provider employed by Penn Highlands Healthcare or with whom our providers share a referral relationship. The patient must also fall below 350% of the federal poverty guidelines for income, have limited assets and struggle to pay their prescription copays.

Eligible Services

The Penn Highlands Pharmacy Financial Assistance Program is designed to help with prescription copays for patients who meet the criteria.

Determination of Penn Highlands Pharmacy Financial Assistance Eligibility

Generally, individuals are eligible for financial assistance based upon their income level according to the federal poverty guidelines and their ability to pay.

• Individuals may be eligible to participate in the Penn Highlands Pharmacy Financial Assistance based upon their income level according to the federal poverty guidelines and their household size.
• Patients must fall below 350% of the federal poverty guidelines for income and have limited assets to qualify. To view the federal guidelines, visit http://hhs.gove/poverty.
• To begin the process, call ProAct at 1-888-381-3272 and provide the representative with your current income and household size information.
• If you qualify based on the information you provide, a verbal one-time use authorization will be provided during the call. The call center will fax the Penn Highlands community pharmacy processing information for each patient once they are temporarily enrolled.
• In order to continue receiving the copay savings, you will be required to submit proof of income documentation to ProAct within 30 days of the verbal authorization.
• Proof of income must be submitted from all eligible sources for all household members including the most recent pay stub showing the gross pay; most recent signed 1040 tax return and/or all W-2s and 1099s for the prior year.
• Patients who do not provide income verification during their temporary period, will have their participation in the program revoked.