Financial Assistance Policy


Financial Assistance for Patients

Catholic Health Initiatives (CHI) understands that paying for emergency and/or medically necessary medical care can be difficult, particularly for patients who lack health insurance. As part of our ongoing commitment to our patients, CHI works hard to help our patients address their financial responsibilities in a way that is fair and sensitive to their circumstances. We have instituted a program designed specifically to help those who find themselves in financial distress.

The Program
The CHI Financial Assistance Policy (available in multiple languages) applies to uninsured/underinsured patients who come to our facilities for treatment. This policy provides financial relief to patients who qualify based on a comparison of their financial resources and/or income to Federal Poverty Guidelines. The program is designed specifically for non-elective care patients whose household financial resources and/or income are at or below 300 percent of the Federal Poverty Level.

To qualify for any assistance, uninsured/underinsured patients will be asked to complete a CHI Financial Assistance Application (available in multiple languages) which includes information relating to household income.

We are committed to working with our patients to establish an appropriate payment plan based on the amount due and the patient’s financial status.

To view a list of providers that are included and/or excluded from the Financial Assistance Policy, please click on this link, Provider List.

If you have questions regarding qualifying or applying for financial assistance, please contact Jane Kuberski at or 641-437-3559.

To view/print a policy or form, simply click on the below link.

Financial Assistance Policy - English                 
Financial Assistance Policy - Spanish
Financial Assistance Policy - German
Financial Assistance Policy - Vietnamese
Financial Assistance Policy - Chinese

Financial Assistance Form - English
Financial Assistance Form - Spanish
Financial Assistance Form _ German
Financial Assistance Form - Vietnamese
Financial Assistance Form - Chinese

Stewardship Policy No 15 - English
Stewarship Policy No 15 - Spanish
Stewardship Policy No 15 - German
Stewarship Policy No 15 - Vietnamese
Stewardship Policy No 15 - Chinese

Stewardship Policy No 16 - English
Stewardship Policy No 16 - Spanish
Stewardship Policy No 16 - German
Stewardship Policy No 16 - Vietnamese
Stewardship Policy No 16 - Chinese