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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

MONTCLAIR HOSPITAL MEDICAL CENTER

5000 SAN BERNARDINO STREET
MONTCLAIR, CA 91763
http://www.mhmc.com

License:

General Acute Care Hospital
Total Beds: 106
Emergency Room: Yes
more... Link to Atlas

Contact:

Monique Andreas
(909) 625-5411

OSHPD ID:

106361166

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

12/31/2021

Download:

Federal Poverty Level for Free Care:

400%

Discount Payment Effective Date:

12/31/2021

Discount Payments

FPL Range: 400%-450%
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:

12/31/2021

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received

Language Information

Available Languages:

English
Spanish

Additional Information

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