Patients & Visitors

I-Care Fund

Indiana Regional Medical Center’s I-Care Program helps eligible persons receive non-elective health care services at no cost or reduced cost, depending on their family income. Please see the following income range table to determine your eligibility and share of covered charges.

Income Range Less Than or Equal to

Family
Size

Category A

Category B

Category C

Category D

1

$11,770

$23,540

$35,310

$47,080

2

$15,930

$31,860

$47,790

$63,720

3

$20,090

$40,180

$60,270

$80,360

4

$24,250

$48,500

$72,750

$97,000

5

$28,410

$56,820

$85,230

$113,640

6

$32,570

$65,140

$97,710

$130,280

7

$36,730

$73,460

$110,190

$146,920

8

$40,890

$81,780

$122,670

$163,560

For each additional family member, add:

$4,160

$8,320

$12,610

$16,640

If your income is less than or equal to the amount in Category A, and you do not have assets exceeding $10,000 individual or $15,000 couple, you are eligible for no-cost health care services. These figures are defined by the Department of Health & Human Services guidelines for the period March 20, 2015 to March 20, 2016.

The patient’s share of charges is as follows:

  • Category A: 0 percent
  • Category B: 25 percent
  • Category C: 50 Percent
  • Category D: 75 percent

For more information, call 724.471.1474.

For your convenience, an Indiana Regional Medical Center representative will make a written determination of your eligibility for the I-Care Fund within 2 working days of your request.

Medical assistance denial letter, stating excess income, required for all self-pay patients and those with insurance deductibles greater than $1,000.

Application Process

If you are interested in applying for the I-Care Fund, download the I-Care Fund application (PDF). Please complete the form in its entirety.

Mail or bring to the Financial Counseling office along with the following:

1. Proof of income.

  • Household income.
  • Income tax return.
  • Pay stubs for one month.
  • Unemployment compensation.
  • Social Security verification.
  • Pension.
  • Workers compensation.
  • Sick benefits.
  • Self-employment.
  • Rental income.
  • Child support.
  • Interest or dividends.
  • Any other income into the household.
  • MA162 with income information.

2. Proof of assets.

  • Checking account balance.
  • Savings account balance.
  • Certificate of deposit (CD).
  • US  savings bond.
  • Stocks or bonds.
  • HRA, HAS, FSA, or any medical savings account.

3. Medical assistance application may also be required.

4. All applicants are required to bring in their previous year's tax return.

Completed application can be mailed or returned in person to:

Indiana Regional Medical Center
Attn: I-Care
P.O. Box 788
Indiana, PA 15701

The Financial Counseling office is located on the second floor of the Urgi-Care building. Application hours are Monday through Friday from 8 a.m. to 3:30 p.m. Please call 724.471.1474 to schedule an appointment.

Contact Us

Phone: 724.471.1474

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