Application for Medical Debt Relief

Indiana Health Fund welcomes applications for medical debt relief to assist those in the community that are facing financial hardship and possible medical bankruptcy due to medical bills. Please review the following list of qualifications and required materials for medical debt relief:

1.) Applicants must have income levels between two and four times above the federal poverty level

2.) Provide an Explanation of Benefits from your insurance provider

3.) Provide the Medical Bill from your healthcare provider

4.) Provide your most recent Tax Return or within the last two years

5.) Provide two of your most recent Pay Stubs

6.) Provide a Release of Records form from the hospital

7.) Indiana Health Fund will run a Credit Report once an applicant has qualified and has agreed to accept medical debt relief

8.) Applicants must complete the following application:  IHF Medical Debt Relief Application

All of these materials can be submitted through the IHF Medical Debt Relief Application. If you have any questions please contact Colleen Rusnak via email at: crusnak@indianahealthfund.org

 

 

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