Health First Requirements

Health First (Blue Card) - click for Espanol

Welcome to Cooper Green Mercy Hospital, Jefferson Outpatient Care.

The Jefferson Health System offers financial assistance to residents of Jefferson County only to help pay for medical bills and medicines for patients who qualify through the Health First program.

To apply for the Health First program you will need to come to the Enrollment Office located on the first floor of Cooper Green Mercy Hospital near the lobby.

Office hours are Monday through Friday from 7:00am to 3:00pm.  If you are unable to come to the office during those hours, please call for an appointment, (205)930- 3377.

You must enroll for the card before your clinic appointment or pharmacy needs.  If you come to enroll the day of your appointments, you may be delayed or you may miss the appointment.

What is Required for Enrollment?

You must bring documents such as those listed below that apply to you and your family as proof.  Jefferson County assistance cannot be granted without this proof and you may be asked to bring additional documents for your spouse and/or dependents.

Identification /Any One of the following:

·        Valid Alabama Driver’s License

·        Valid Alabama Identification Card

·        Government Photo Identification

·        Credit Card with Photo Identification

·        School ID Photo

One (1) YEAR - State of Alabama Residence

State residency the documents listed below must be one (1) year old

                            and

30-DAYS – Jefferson County Residency

(County residency, the  documents listed below must be current within the last 30 days)

any one of the following:

·        Utility bill (electric, phone, water or gas)·       Rent Receipt or Lease

·        Any type government mail

·        Property Tax Card

·        Employment Information

·        Mortgage, Car or other Payment Coupon Book

·        School Records

Social Security Number:

·        Social Security Card

·        Social Security Number

·        If no Social Security Number bring two (2) other forms of personal identification

PROOF OF INCOME:  Includes spouse and children’s income

                       (provide the following items listed below)

Employed:

·        Current check stub with year-to-date income

·        Check stubs for last three (3) months if no year-to-date amount on stub

·        Letter from employer stating hourly wage, number of hours worked per week & how  long at the job

·        School work study award letter

Self-Employed Persons:

·        Most recent year’s tax return

·        Statement of gross income and expenses for the most recent three (3) month time period

Not Working (but receiving a check):

·        Any type of pension or survivors’ benefits

·        Military allotment

·        Court ordered child support

·        Rent from boarders

·        Unemployment or worker’s compensation

·        A signed & dated letter from the person assisting you and what type of assistance such as food and shelter.

·        A signed & dated letter from the person assisting you that states what type of help you are given, how much money is given to you and how often it is given to you.

·        The person providing assistance must provide their phone number.

·        Award letter if dependent children receiving Social Security or Aid to Families with Dependent Children.

·        Interest income or other check(s)

·        Financial Aid Award letter

The Enrollment Counselor will explain your co-payment for services after the enrollment process has been completed.  You will receive a separate bill(s) from the doctor(s).

If you do not provide all information or if you provide false information, Jefferson County Assistance will be revoked and you will be responsible for full charges.

If your family or employment situation does not fit one of these categories, please have information and documents available that you think will assist our Counselors to complete the enrollment or call our office at (205) 930- 3377.