HCAI Syfphr

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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

CHILDREN'S HEALTHCARE ORGANIZATION OF NORTHERN CA - PEDIATRIC HOSPITAL

3777 SOUTH BASCOM AVENUE
CAMPBELL, CA 95008
http://www.pedisubacute.com

License:

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

Contact:

Marla Diamond
(408) 558-3640

OSHPD ID:

106434051

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

1/1/2008

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

1/1/2008

Discount Payments

FPL Range: 201%-250%
Payment Basis:
Medi-Cal
Other: 75% discount

FPL Range: 251%-300%
Payment Basis:
Medi-Cal
Other: 50% discount

FPL Range: 301%-350%
Payment Basis:
Medi-Cal
Other: 25% discount

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

1/1/2008

Download:

Income Type Used:

Salary Received

Language Information

Available Languages:

English
Spanish

Additional Information

This policy is under review by our legal counsel. Any required changes will be made as soon as possible.

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