Global Health Linkages, Inc. provides a free Co-Pay relief service that provides direct financial support to medically and financially qualified insured patients. Including those covered by government sponsored plans such as Medicare, Tricare, and Medicaid, for co-payments related to medical appointments.The Co-Pay Rescue Program relieves the financial burden to access high quality care.
To qualify for the Co-Pay Rescue Program you must have the following requirements listed below.
• Patients must have eligible and active insurance
• Patients must have a qualifying, verified diagnosis of the disease or condition for which they seek financial assistance
• Patients must reside and receive treatment in the United States
• Patient’s income must fall at or below 400% of the Federal Poverty Guideline (FPG) with consideration of the Cost of Living Index and number in the household. The Federal Poverty Guidelines for 2019 can be found here.
To complete a Co-Pay Rescue Application online you must have a Google Mail (Gmail) account. Otherwise you can download an application form and bring a printed copy, along with the supporting information with you to any of the Community Behavioral Health centers.
In order to successfully apply online, you must have electronic copies of the supporting information listed below.
Please have the following information ready to complete your application:
- Patient demographics: Name, address, Social Security Number and phone number.
- Income: Adjusted gross income applicable for the patient and all members of the patient’s household i.e self, spouse, relatives, others with total income for the house.
- Insurance Card: Health insurance and pharmacy card(s).
- Physician demographics: Prescribing physician or clinic name, phone number and facility address.
- One of the following for Proof of Income (if employed): 1040, W2, 2 recent pay stubs, written statement by employer.
- One of the following for Proof of Income (if unemployed) – Public Assistance check stub/copy, Certificate Letter from Medical Assistance or Department of Social Security Services, Completed zero income form, written statement from friend or relative with whom the patient lives (if forms not available), Letter of reference from a 501 (c) (3) organization, such as a church (if other forms not available).
- Proof of Address; one of the following: Driver’s license, MVA ID, Any document (envelope) recently addressed to patient such as a utility bill.
- A written statement by relative of friend with whom patient lives.
- Proof of Address (Immigrants) one of the following: From 1551 or Form 194.
Please note, all applicants are required to attest that the application information provided is complete and accurate. Reported financial information may be verified by an audit, as deemed necessary by GHLI.