About HealthLinc IUSB Campus South Bend Medical Clinic
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Financial assistance options for uninsured and underinsured families and individuals
To determine your eligibility for support programs and sliding fee scales, we will need some information from you when you come for your intake appointment. Please bring the following information. If any information is missing, your intake appointment will be rescheduled. If you have questions, please call your local HealthLinc clinic and ask to speak with the Intake Coordinator.
Birth certificate or passport
Photo identification (driver's license, state ID, school ID)
Social security number
Medicaid, Medicare or commercial insurance card (if applicable.) If a child has been denied Medicaid, bring the denial letter
Proof of current resident (e.g. utility bill, bank statement, phone bill)
Last year's federal tax return (1040 form) or waiver of filing (From 4508-T)
Paycheck stubs for most recent 30 days (if employed.) If you (or someone in your household) works but do not have pay stubs, provide a signed letter from your employer on the employer's letterhead (with contact name and phone number) and the amount you are paid.
Proof of any other sources of income: unemployment, Social Security, pension/401(k)/annuities, worker's compensation, disability, self employment profit or loss, etc
If you have no income, please bring a œfood and shelter letter from the person with whom you are living (this is a letter signed by that person stating that they are providing you with food and shelter). This letter must be dated, provide the address, and be signed by the person with whom you are living.
Since this is a sliding fee scale clinic, we have provided the Federal Poverty Guidelines below. Visit the HealthLinc IUSB Campus South Bend Medical Clinic website listed above to see what the level is needed for free care.
Federal Poverty Guidelines for 2021
| Persons In Family Household | Poverty Guideline Salary per year |
|---|
| 1 | $12,760 |
| 2 | $17,240 |
| 3 | $21,720 |
| 4 | $26,200 |
| 5 | $30,680 |
| 6 | $35,160 |
| 7 | $39,640 |
| 8 | $44,120 |
For Households with more than 8 persons, add $4,480 for each additional person.
*Alaska and Hawaii have different rates for HUD federal poverty guidelines.
These numbers above represent 100% of the Federal Poverty Rate. In order to get reduced or free services from some clinics, they use a sliding fee scale based on your income.When they use a sliding fee scale, the 100% rate can be different than 100%. In those cases, using for example a 200% federal poverty level, you will only need double the 100% number listed above to 200%.
COVID-19 Information for Patients
Contact your healthcare provider by phone before coming to a clinic or hospital if you meet the following criteria:
- Symptoms such as fever, cough or shortness of breath, fatigue, headache
- Symptoms such as muscle or body aches, loss of taste or smell, sore throat, congestion or runny nose.
- Contact with someone with confirmed COVID-19 within 14 days of onset of systems
Mild Covid Symptoms
- Low-grade fever (approx 100 degrees Fahrenheit for adults)
- Nasal congestion
- Runny nose
- Mild, dry cough
- Mild body aches
Moderate Covid Symptoms
- Fever above 100.4 F
- Persistent cough
- Temporary shortness of breath when you exert yourself
- Exhaustion, need to stay in bed
Severe Covid Symptoms
- Constant trouble breathing
- Persistent chest pain or pressure
- Confusion
- Trouble staying awake
- Blue lips or face
