Patients & Visitors

I-Care Fund

Indiana Regional Medical Center’s I-Care Fund helps eligible patients receive health care services at little or no cost, depending on their household income. Please see the following 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

$11,670

$23,340

$35,010

$46,680

2

$15,730

$31,460

$47,190

$62,920

3

$19,790

$39,580

$59,370

$79,160

4

$23,850

$47,700

$71,550

$95,400

5

$27,190

$54,380

$81,570

$108,760

6

$31,970

$63,940

$95,910

$127,880

7

$36,030

$72,060

$108,090

$144,120

8

$40,090

$80,180

$120,270

$160,360

For each additional person, add:

$4,060

$8,120

$12,180

$16,240

If your family income is less than or equal to the amount in category A, you are eligible for free health care services. These figures are defined by the Department of Health and Human Services guidelines for the period March 20, 2014 to March 20, 2015.

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, a Financial Counselor will make written determination of your eligibility for the I-Care Fund.

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 Patient Financial Services Office along with the following:

1. Proof of income.

  • Household income
  • Income tax return (if applying in first three months of calendar year).
  • Pay stubs for one month (for applications April through December).
  • 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/PFS
P.O. BOX 788
Indiana, PA 15701

The I-Care office is located on the second floor of the Urgi-Care Building. Application hours are Monday-Thursday from 8 a.m. to 3:30 p.m.

Contact Us

Sheila Henry
Phone: 724.357.7018

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