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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

MISSION OAKS HOSPITAL

15891 LOS GATOS-ALMADEN ROAD
LOS GATOS, CA 95032
http://www.goodsamsanjose.com

License:

General Acute Care Hospital
Total Beds: 70
Emergency Room: Yes
more... Link to Atlas

Contact:

Taylor Randalls
(615) 234-6150

OSHPD ID:

106430915

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

6/16/2020

Download:

Federal Poverty Level for Free Care:

400%

Discount Payment Effective Date:

6/16/2020

Discount Payments

FPL Range: 401%-600%
Payment Basis:
Other: Balances capped at 10% of annual income

FPL Range: 601%-800%
Payment Basis:
Other: Balances capped at 12% of annual income

FPL Range: 801%-999%
Payment Basis:
Other: Balances capped at 15% of annual income.No FPL max

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

1/1/2022

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received

Language Information

Available Languages:

English
Spanish

Additional Information

THE EFFECTIVE DATE OF THE CHARITY AND UNINSURED POLICIES IS 11/01/2017

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