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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

SANTA MONICA - UCLA MEDICAL CENTER AND ORTHOPAEDIC HOSPITAL

1250 16TH STREET
SANTA MONICA, CA 90404
http://uclahealth.org

License:

General Acute Care Hospital
Total Beds: 281
Emergency Room: Yes
more... Link to Atlas

Contact:

Helen Contreraz
(310) 825-7047

OSHPD ID:

106190687

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

1/1/2022

Download:

Federal Poverty Level for Free Care:

400%

Discount Payment Effective Date:

1/1/2023

Discount Payments

FPL Range: 401%-450%
Payment Basis:
Medicare
Medi-Cal
Healthy Families
Other Government Insurance

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

1/1/2016

Download:

Income Type Used:

Salary Received

Language Information

Available Languages:

English
Spanish
Russian
Other: Farsi, Arabic

Additional Information

Family Size	100%	150%	200%	250%	300%	350%	400%