Financial Services

Santa Clara Valley Health & Hospital System is committed to ensuring residents receive high quality, affordable and accessible health care. While every patient is responsible for the costs of the health care services they receive, there may be programs available to assist in reducing these costs for those who do not have health insurance. (See “Apply for A Program” below.) Our friendly staff is here to help determine which program you may be qualified to enroll.

If you are covered by insurance, it is important that you know and fully understand your policy, responsibilities and insurance benefits. Our Financial Counselors are available to help you, but understanding your benefits and insurance policy is your responsibility. It is also your responsibility to provide your insurance information to the Financial Counselor and to the Health Services Representative upon hospitalization or at every clinic visit.

If you have no insurance and do not qualify for one of the financial assistance programs, a deposit will be requested. You will be expected to pay for your healthcare. Payment installment plans are available by cash, check, Visa, or MasterCard.

If you have already applied for a publically sponsored program, the program will be billed for regular charges. Depending on the program, you may be responsible for co-pays, deductibles or share-of-costs that the program does not cover.

If you have questions or need to speak with a Financial Counselor in the Patient Access Department at SCVMC, please call (866) 967-4677 (toll free).

SCVHHS Patient Access Department
770 South Bascom Avenue 
San Jose, CA 95128 
(866) 967-4677 (toll free)​


How to Apply for a Financial Assistance Program​

If you do not have medical insurance, we have Financial Counselors who can help you apply for a financial assistance program. You will need to fill out a Financial Assistance Application and provide all the required documents. The information you provide will determine which program you may qualify for.

Here is how to apply for a program:

STEP 1: COMPLETE A FINANCIAL ASSISTANCE (FAA) PACKET​

A completed and signed FAA must be submitted to us before we can determine whether or not a financial assistance program may be used to help pay for your health care bills. Locations to Get a Packet.

Applications must be complete to be processed and you must have all of the required documents. Applications that are not finished and/or do not have all the documents are not accepted and will not be processed. 

FAA-fill-in English -12-07-12.pdfFAA Application in English
FAA-fill-in Spanish 03-04-13.pdfFAA Application in Spanish

Step 2: Provide All Required Documents (link to Document Checklist)

You will need to provide copies of the following documents with your application, including the following:

  • Proof of identity
  • Proof of Santa Clara County residency
  • Proof of income

When you have all your documents, attach them to your completed application and turn them in. See the Document Checklist for a list of the documents you will need.

Step 3: Get All Information to the Patient Access Department

Completed applications with all the required documents can be faxed to SCVHHS at (408) 494-7848, or scanned and e-mailed to: HHSVCApp@hhs.sccgov.org.

You may also drop off the completed application and documents in person to: SCVHHS Patient Access Department, 770 South Bascom Avenue, San Jose, CA 95128.

Once received, the packet will be reviewed according to the rules and regulations for each program or agency. Using these rules, the staff will determine if you are eligible for a state program, a county program, a discount, or full financial assistance.

​Santa Clara Valley Health & Hospital System is committed to ensuring residents understand what health care options are available, including what the Affordable Care Act (ACA) offers. The ACA, also known as Health Care Reform or Obamacare, means more people will have access to affordable health insurance. It started January 1, 2014 and if you have any questions, our Patient Access Department can help. They can also help you apply for a program.

A number of health care events are being held in our community. At http://scchealthconnection.org you can find events that provide information and/or assistance with any of the health coverage programs available in Santa Clara County, including Covered CA, and Medi-Cal.

If you are in the Medi-Cal Program: 

Your coverage is the same, you just need to renew every year like you do now. It is important to know this program is expanding and more people will be eligible for Medi-Cal, which is free.

If you are a citizen/legal resident and uninsured: 

You need to get insurance through Medi-Cal or Covered California. Financial assistance may be available and our Patient Access Department can help you enroll. Because of the Affordable Care Act, many more people are able to get Medi-Cal. Even if you did not qualify before, you may be able to qualify now. Our Patient Access Department can help.

If you are in our Ability to Pay “APD” Program:

APD will continue for some people like those who are undocumented persons or are not eligible for Medi-Cal.

If you do not qualify for health coverage:

People who cannot be on a program because of citizenship, residency or other reasons can still get care in our system.

If you already have health insurance: 

Your benefits may be changing and you should check with your health plan to find out.



Affordable Care Act (ACA) Frequently Asked Questions

What is “health care reform”?

The term “health care reform” refers to the Affordable Care Act and any other laws to put it into place to make it happen. The goal of these laws is to help more people get affordable health insurance and better medical care.
One key part of the ACA is that state’s Medi-Cal program is expanding. More people will be eligible for Medi-Cal, which is free. If you are currently on Medi-Cal your coverage will be the same and you just need to renew every year like you do now.

Who has to buy health insurance?

Most people will have to have a basic level of health coverage starting January 1, 2014. Some people will not have to buy health insurance because of their income or other reasons. Our Patient Access Department can help you find out what you may qualify for.

SCVHHS Patient Access Department
770 South Bascom Avenue 
San Jose, CA 95128 

(866) 967-4677 (toll free)

Or you can go to www.coveredca.com for more information about Covered California plans and apply online.

What if I cannot afford health insurance?

Depending on your income and family size, you may qualify for financial help to pay these costs.

What services will be covered?

Most medically necessary services will be covered. This includes preventive care and well-care visits for men, women and children. Other benefits include immunizations, cancer screenings, prescriptions, laboratory services, behavioral health services, hospital and emergency care.

What if I am not eligible for health insurance under the Affordable Care Act?

Santa Clara Valley Health & Hospital System with Santa Clara Valley Medical Center and its clinics are here to help you NOW. Santa Clara County residents who cannot be on other programs because of citizenship, residency, age, or other reasons still get care a nearby clinic.

About Health Care Reform (English)


Other Frequently Asked Questions

Here are some answers that you may find helpful in applying for financial assistance.

How do I apply for a Health Care Coverage Assistance Program?

To apply follow these easy steps:

      1. Complete a Financial Assistance Application (FAA) Packet
        FAA-fill-in English -12-07-12.pdfFAA Application in English
        FAA-fill-in Spanish 03-04-13.pdfFAA Application in Spanish
      2. Provide all required documents
      3. Return your completed packet to the Patient Access Department

Where can I get a Financial Assistance Application (FAA) Packet? 

Packets are available at Santa Clara Valley Medical Center and Valley Health Centers. Locations to Get a Packet

What documents are required?

A number of documents are required and include Proof of Identity; Proof of Residency in Santa Clara County; Proof of U.S. Citizenship or Permanent Residency; Proof of Income and Assets. You can see the full list in the Document Checklist

Can I turn in a partial filled out application and just some of the documents to start the process?

No. Applications are only accepted when complete. Applications are processed only when all the required documents are included. 

What if I don’t qualify for financial assistance?

Every effort will be made to see if you qualify for assistance. If you do not qualify for any discount or program, you will be notified and you will be responsible to pay for your medical bills.

Can I choose which financial assistance program I want to use?

No. Each program has set conditions and measures for acceptance. The information you provide will determine whether or not you qualify for a state or county program, a discount program, or another financial assistance program. A review of your information will determine which program best suits your needs and offers you the most financial assistance, based upon your financial qualifications.

Is all information I provide confidential?

Yes.  All information you provide is held in the strictest confidence. Only authorized SCVHHS staff and official representatives of a program or agency providing services have access to your information. Federal confidentiality rules apply to your application and documents.


 

Your Document Checklist

For your Financial Assistance Application*, please review this Checklist.

You can submit COPIES of the following documents:

o Proof of Residency in Santa Clara County – Provide ONE of the following:

  • Rental Contract/Lease
  • Mortgage Statement
  • Utility Bill (Water, Electric Gas, Garbage)

o Proof of Identity (Photo ID Required) – Provide ONE of the following:

  • Driver’s License
  • Passport
  • Government-issued ID Card
  • Work or School ID Card

o Proof of Income – Provide ALL that Apply:

  • Check Stubs (all stubs not older than 45 days from application date)
  • Tax Return (current tax year)
  • Award Letter (Social Security, Disability, Unemployment, Worker’s Compensation)
  • Cash Income Statements (including tips)
  • Military Benefits Statement
  • Rental Income Receipts

If Required – these documents must be ORIGINALS

* Depending on a person’s declarations and/or differences in documentation, additional documents may be required. If more documents are required, you will be instructed which documents to provide. You will also be given a deadline for returning additional documents to the SCVHHS Patient Access Department.

‡ Eligibility for some programs requires that a person provides proof of U.S. Citizenship or U.S. Permanent Residency. If you are eligible for a program that requires proof of citizenship or permanent residency, you will be instructed to bring original documents (copies will not be accepted) to the financial screening interview. Undocumented individuals may be eligible for programs that do not require proof of U.S. Citizenship or U.S. Permanent Residency.


Locations to Get a Packet

Financial Assistance Application Packets are available at these convenient locations:

SCVHHS Patient Access Department
770 South Bascom Avenue
San Jose, CA 95128
Get Directions

SCVMC Admitting Department
751 South Bascom Avenue
San Jose, CA 95128
Get Directions

Valley Health Center East Valley
1993 McKee Road
San Jose, CA 95116
Get Directions

Valley Health Center Gilroy
7475 Camino Arroyo
Gilroy, CA 95020
Get Directions

Valley Health Center Milpitas
143 North Main Street
Milpitas, CA 95035
Get Directions

Valley Health Center Sunnyvale
660 South Fair Oaks Avenue
Sunnyvale, CA 94086
Get Directions


When Information Changes

If your information has changed – you will need to call the Patient Access Department at 866-967-4677. Everyone must call about changes such as:

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  • NEW Home Address
  • NEW Phone Number
  • NEW E-mail Address
  • NEW Contact Information
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  • Had another Child or Adopted a Child
  • Child Moves in or out of Home
  • A Death in the Family
  • Got Married
  • Are Getting Divorced
  • Are Legally Separated
  • Have a Registered Domestic Partner
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  • Became Unemployed
  • Salary Changed
  • Got an Extra Job
  • Your Spouse’s Employment or Salary Changed
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  • Income Changes
  • Investments or Assets Changes
  • Got an Inheritance or Pension
  • Bought or Sold Property

Please Call Patient Access to update any of your information when it changes. 866-967- 4677​​​​​​​​​​​​​

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