QNatal™ Advanced NIPS
Financial Assistance
Ensure all of your patients receive the testing
they require. Quest Diagnostics offers flexible and
easy-to-use financial assistance for those who
cannot afford Noninvasive Prenatal Screening
(NIPS). Affordability shouldn’t stand in the way of
diagnostic insights. Let’s help find every patient a
solution that fits their financial need.
• For
uninsured and underinsured patients who
meet or fall below the federal poverty level, testing
is provided at no charge
• U
ninsured and underinsured patients that
meet income requirements (household incomes
of greater than 100% and at or less than 400% of
the federal poverty level) will qualify for an
out-of-pocket maximum of $200
• F
inancial criteria information is available on the
U.S. Department of Health and Human Services
(HHS) website at http://aspe.hhs.gov/poverty
To Qualify:
• P
atient must meet income requirements. See the 2015 HHS
financial guidelines on the back of this page
• I f insured, patients must meet their insurance provider’s
requirements for this testing, such as obtaining
preauthorization for testing
How to apply:
• D
ownload the application at the URL below and mail it to the
address listed on your invoice, or call the Customer Service
phone number listed on your invoice
QuestDiagnostics.com/financialassistance
For patients who require
additional financial assistance,
Quest Diagnostics offers
payment plans of 0% financing
for a 12-month period.
QNatal™ Advanced NIPS
Financial Assistance
2015 HHS Poverty Guidelines
Income Requirements for Eligibility
48 Contiguous States &
Washington, DC
Alaska
Hawaii
Persons
in Family/
Household
Poverty level
x 400%
Poverty level
x 400%
Poverty level
x 400%
1
$11,770
$47,080
$14,720
$58,880
$13,550
$54,200
2
$15,930
$63,720
$19,920
$79,680
$18,330
$73,320
3
$20,090
$80,360
$25,120
$100,480
$23,110
$92,440
4
$24,250
$97,000
$30,320
$121,280
$27,890
$111,560
5
$28,410
$113,640
$35,520
$142,080
$32,670
$130,680
6
$32,570
$130,280
$40,720
$162,880
$37,450
$149,800
7
$36,730
$146,920
$45,920
$183,680
$42,230
$168,920
8
$40,890
$163,560
$51,120
$204,480
$47,010
$188,040
For families/households with more
than 8 persons, add $4,160 for each
additional person.
For families/households with more
than 8 persons, add $5,200 for each
additional person.
For families/households with more
than 8 persons, add $4,780 for each
additional person.
The financial assistance application is available at:
QuestDiagnostics.com/financialassistance
Please contact your sales representative for additional information.
Note: The financial criteria above are based upon the United States Department of Health & Human Services (HHS) Poverty Guidelines 2015.
Our illustration provides an estimate of the poverty level multiplied times 400%, which are subject to change when these levels change each year.
Quest Diagnostics reserves the right to modify or terminate this program at any time.
For more information please access the HHS website at http://aspe.hhs.gov/poverty
QuestDiagnostics.com
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All rights reserved. MI4503 04/2015