HCAI Syfphr

Search > Results > Details

Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

SAN GABRIEL VALLEY MEDICAL CENTER

438 W. LAS TUNAS DRIVE
SAN GABRIEL, CA 91776
http://www.sgvmc.org

License:

General Acute Care Hospital
Total Beds: 273
Emergency Room: Yes
more... Link to Atlas

Contact:

Lorna Laraya
(626) 289-5454

OSHPD ID:

106190200

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

1/1/2015

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

1/1/2015

Discount Payments

FPL Range: 201%-500%
Payment Basis:
Medicare
Medi-Cal
Healthy Families
Other Government Insurance

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

1/1/2015

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: Unemployment Ins and Disability Insurance

Language Information

Available Languages:

English

Additional Information

Family Size	100%	150%	200%	250%	300%	350%	400%