Get Financial Assistance Application - Coxhealth.com

This guide provides a clear and supportive approach to successfully completing the Financial Assistance Application from CoxHealth online. Understanding each component of the application will help ensure your submission is accurate and complete.

Follow the steps to efficiently complete the Financial Assistance Application.

1. Press the ‘Get Form’ button to obtain the financial assistance application and open it in your preferred document viewer.
2. Begin by verifying all household income. Collect necessary documentation that outlines your income sources, such as paycheck stubs for employed individuals, verification for self-employed persons, and any other relevant income statements.
3. If employed, include the three most recent paycheck stubs for each wage earner in your household. For self-employed individuals, provide documentation of gross income including business expenses and prior year tax returns.
4. If you are receiving unemployment benefits, include a copy of your latest unemployment check. If not currently working, provide a brief description of your situation along with your expected date of return to work.
5. Collect additional income verification such as pension statements, child support agreements, or other income sources, along with appropriate documentation.
6. Prepare your prior year’s tax return, ensuring it is complete and includes all relevant forms such as W-2s and 1099s. If not required to file, provide written confirmation of the reason along with any relevant income documentation.
7. If applicable, provide any Missouri Health Net, Medicaid, or Marketplace eligibility documentation including denial letters or approval statements.
8. Complete the Financial Statement form in its entirety, ensuring all areas are filled, even if you must note 'none' or 'N/A.' Be thorough with listing assets and liabilities to aid in assessing your application.
9. Ensure the signed Application for Assistance form and all other required documentation are included before returning the application. Keep copies of everything for your records.
10. Submit your completed application and accompanying documents within 30 days to ensure eligibility for consideration.
11. Once all documentation is provided and the application is submitted, you can save changes for your records and prepare for follow-up if necessary.

Take action now and complete your Financial Assistance Application online to receive the assistance you need.