Get Financial Assistance Form - Musc Health

Completing the Financial Assistance Form for MUSC Health is a crucial step towards obtaining necessary medical services when financial challenges arise. This guide provides clear and concise instructions to help you navigate the form with ease.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Financial Assistance Form and open it in your preferred editor.
2. Begin by entering your personal details, including your full name and account number if applicable. Ensure that all information is accurate and up to date.
3. Answer the residency question by indicating whether you are a South Carolina resident. Choose either 'Yes' or 'No'.
4. Indicate your current insurance status by selecting 'Yes' or 'No' and provide any necessary information related to your insurance if applicable.
5. Respond to the citizenship question. If you select 'Yes', you must attach a legible copy of a valid South Carolina Driver’s License or picture ID. If 'No', also provide a legible copy of a valid Green Card.
6. Fill in the name and policy number of your insurance provider, if insured.
7. State the number of dependents claimed on your tax return or currently living in your household. Note that all dependents need to provide the same proof of citizenship as required.
8. Provide your yearly gross household income, including all family members, in the designated field.
9. Enter the Social Security number of the responsible party; this will be used for processing your application.
10. List your monthly expenses such as rent/mortgage, insurance payments, utilities, car payments, and medical expenses in the specified fields.
11. Document your savings and liquid assets, including checking accounts, certificates of deposit, money market accounts, stocks, and bonds in the relevant sections.
12. Review the certification statement, sign, and date the application. This confirms that all information provided is accurate to the best of your knowledge.
13. Save your changes, download the completed form, print it for your records, or share it as needed.

Complete your financial assistance form online today to start the process.