The HMH Hospitals Corporation (“Hospitals”) Financial Assistance Policy and Financial Assistance Policy (Charity Care/Kid Care/Medicaid) (hereinafter, together, “FAP”) exists to provide eligible patients partially or fully-discounted emergency or other medically necessary health care services provided by HMH Hospitals Corporation. Patients seeking Financial Assistance must apply for the program, which is summarized below.

Eligible Services

Emergency or other medically necessary health care services provided by Hospitals and billed by hospitals. The FAP only applies to services billed by Hospitals. Other services which are separately billed by other providers, such as physicians or laboratories, are not eligible under the FAP.

Eligible Patients

Patients receiving eligible services, who submit a complete Financial Assistance Application (including related documentation/information), and who are determined eligible for Financial Assistance by Hospitals.

Website: An individual can view information about financial assistance online at the following website: https://www.hackensackmeridianhealth.org/en/Pay-Bill/Financial-Assistance

How to Apply

FAP and related Application Forms may be obtained as follows:

Application

An individual can apply for financial assistance by completing an initial screening to determine if eligible for financial assistance and/or completing/signing an application. (Note: Charity Care is hospital specific so if services were provided at multiple locations, multiple applications must be submitted.) An application is available free of charge by any of the following methods:

Mail, Phone or In person

By writing to the following address, stopping by one of the Financial Assistance Department in person, Monday - Friday.  Hours vary by location at the below hospitals or by phone:

Bayshore Medical Center (Attn: Charity Care)
727 N. Beers Street
Holmdel, NJ 07733
732-902-7080

Hackensack University Medical Center
100 First Street, Suite 300
Hackensack, NJ 07601
551-996-4343

Jane H Booker Family Health Center
1828 W Lake Avenue #202
Neptune, NJ, 07753
732-902-7080

Jersey Shore University Medical Center
1945 Route 33
Neptune, NJ, 07753
732-902-7080

JFK University Medical Center (Attn: Charity Care)
80 James Street, 3rd Floor
Edison, NJ 08818
Patients seen by appointment 
732-321-7534

Ocean University Medical Center (Attn: Charity Care)
425 Jack Martin Boulevard
Brick, NJ 08724
732-902-7080

Old Bridge Medical Center (Attn: Charity Care)
One Hospital Plaza
Old Bridge, NJ 08857
732-902-7080

Palisades Medical Center (Attn: Charity Care)
7600 River Road
North Bergen, NJ, 07047
201-854-5092

Raritan Bay Medical Center (Attn: Charity Care)
530 New Brunswick Avenue
Perth Amboy, NJ
732-902-7080

Riverview Medical Center (Attn: Charity Care)
1 Riverview Plaza
Red Bank, NJ 07701
732-902-7080

Southern Ocean Medical Center (Attn: Charity Care)
1140 Route 72 W
Manahawkin, NJ 08050
732-902-7080

A Charity Care application can also be printed off the Hackensack Meridian Health website by clicking on https://www.hackensackmeridianhealth.org/en/Pay-Bill/Financial-Assistance

Available Languages

The Financial Assistance Policy, application, and plain language summary are available in the primary language of any populations with limited proficiency in English (“LEP”) that constitute the lesser of five (5%) percent or 1,000 individuals within the primary service area served by Hospitals.

Summary  of the Application Process

• Patient completes a written application that requests household income, household assets, family size
• Proof of residency is required in the form of NJ driver’s license, utility bill or other support letter.
• Application is reviewed for completeness and accuracy.
• Request is made to the patient for any missing information
• Application approval or denial is sent.
• Completed applications can be sent to the Financial Assistance Department to one of the addresses above.

Determination of Financial Assistance Eligibility - Generally, Persons are eligible for Financial Assistance, using a sliding scale, when their Family Income is at or below 600% of the Federal Government’s Federal Poverty Guidelines (FPG).

Eligibility for Financial Assistance means that Eligible Persons will hAvenue their care covered fully or partially, and they will not be billed more than “Amounts Generally Billed” (AGB) to insured persons (AGB, as defined in IRC Section 501(r) by the Internal Revenue Service). Financial Assistance levels, based solely on Family Income and FPG, are determined if income is up to 500% of FPG.

Note - Other criteria beyond FPG are also considered (e.g., availability of cash or other assets that may be converted to cash, and excess monthly net income relative to monthly household expenditures), which may result in exceptions to the preceding. If no Family Income is reported, information will be required as to how daily needs are met. Hospitals’ Financial Assistance Department reviews submitted applications which are complete, and determines Financial Assistance Eligibility in accordance with Hospitals’ Financial Assistance Policy. Incomplete applications are not considered, but applicants are notified and given an opportunity to furnish the missing documentation/information.  (Note: Charity Care is hospital specific so if services were provided at multiple locations, multiple applications must be submitted.)

Assistance can be obtained by phone or by stopping by the Financial Assistance Department (Monday thru Friday, 8:00AM-4:00 PM) located at the address listed above.