$25,520
$34,480
$43,440
$52,400
$61,360
$70,320
$79,280
$88,240

$12,760
$17,240
$21,720
$26,200
$30,680
$35,160
$39,640
$44,120

family household size

ClienT Qualification

Gross Annual Income

A family or individual must have an income less than or equal to the cap amount listed on the income chart when compared with household size.

Insurance

All individuals or families with no insurance who meet income criteria as listed above will be able to receive care at Unfailing Love Clinic.

Individuals or families with high-deductible insurance who meet income criteria must evaluate their deductible.  High deductibles per individual must be greater than or equal to $1,250 or $2,500 per family to qualify for services.

Request for Donation for Services

All clients are asked for a $20 donation for services received.  

All laboratory fees are an additional cost.

1
2
3
4
5
6
7
8

For >8 per household add $4,420 per person.

U.S. Health Department of Health and Human Services (2021). 2021 Poverty Guidelines.

200% of Poverty Level

Please fill out the application online (please type in all answers) and submit via one of the options below to become a client at Unfailing Love Clinic.  A staff member will contact you within 2-3 business days to set up an appointment to complete the screening process (Please allow extra contact time if sending application through the post office mail).

Submit your application via:

Email

office@unfailingloveclinic.org

Mail

1040 S. 11th St.

Decatur, IN 46733

            Poverty Guidelines

What to Bring

“We love because He first loved us.”​  1 John 4:19

1.  Completed Application if

     not mailed

2.  Most recent federal tax

     return paperwork or 1

    months recent paystubs.

3.  Photo Identification

4.  Proof of address (recent

     bill, paystub, or bank

     statement-request of 2

     different identifiers).

5.  Copy of Health insurance

     card (if applicable)