HCAI Syfphr

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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

CHILDREN'S HOSPITAL AT MISSION

27700 MEDICAL CTR. RD., 5TH FL
MISSION VIEJO, CA 92691
http://www.choc.org

License:

General Acute Care Hospital
View License Information... Link to Atlas

Contact:

Financial Assistance Liason
(714) 532-7860

OSHPD ID:

106304113

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

6/29/2021

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

6/29/2021

Discount Payments

FPL Range: 201%-300%
Payment Basis:
Other: Equivalent to 75% discount on billed charges.

FPL Range: 301%-400%
Payment Basis:
Other: Equivalent to 50% discount on billed charges.

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

1/1/2022

Download:

Income Type Used:

Salary Received
Other: Most current tax return

Language Information

Available Languages:

English
Spanish

Additional Information

Application updated to reflect same sex couples.

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