Financial Assistance "*" indicates required fields Thanks for using our Eligibility Checker for Financial Assistance! Answer the following questions to see if you may be eligible for a discount on your Carlinville Area Hospital & Clinics bills.Name* First Last Date of Birth Do you have health insurance?* Yes No Including yourself, how many people are in your immediate family?*“Family” is defined as the applicant, the applicant’s spouse, and all of the applicant’s children under 18 (natural or adoptive) who live in the applicant’s home.Please enter a number from 1 to 10.What is your estimated gross MONTHLY household income?*This is current household monthly income before taxes.Please enter a number from 0 to 1000000.HiddenPhone # For Text (Optional)HiddenFamily AdditionalsHiddenFamily Additional Total 5380HiddenYearly Rate 15060HiddenCalculated % FPLHiddenAnnual IncomePhoneThis field is for validation purposes and should be left unchanged.
