Requalification Application
Volunteers in Medicine | Patient ReQualifying Guidelines
VIM requires all existing patients to requalify with us once a year, ensuring that all patients continue to meet our eligibility requirements. This application should ONLY be completed if you are a current VIM patient and have been seen at our clinic in the last 12 months. If you are new to Volunteers in Medicine or a past patient who has not been seen in more than 12 months, you will need to complete the New Patient Qualification Application found under the 'Patient' tab above and selecting 'Become a Patient'.
Patient Eligibility Requirements:
Be an adult between the ages of 18 - 64
You or your spouse/partner work at least 20 hours per week
Be uninsured and currently without health insurance
Have a household gross income before taxes that falls within the income range listed below
| Persons in family/ household |
Qualifying Minimum |
Qualifying Maximum |
||
|---|---|---|---|---|
| 1 | $14,560 | $50,863 | ||
| 2 | $14,560 | $68,738 | ||
| 3 | $14,560 | $86,613 | ||
| 4 | $14,560 | $104,488 | ||
| 5 | $14,560 | $122,363 | ||
| 6 | $14,560 | $140,238 | ||
| 7 | $14,560 | $158,113 | ||
| 8 | $14,560 | $175,988 | ||
Important Things to Know:
Patients must individually requalify. We do not accept one application for an entire household.
If you have not been seen at our clinic in 12+ months, you will need to go through the qualification process again as a new patient.
To remain an active patient, you must submit this application and all necessary pay documents by your requalification deadline.
Before you start this application, we highly recommend that you have your driver's license and four weeks of pay stubs ready to be uploaded. If you are self-employed or have your own business, you will need to upload 90 days of your business bank statements.
If you need additional assistance with the form below, please email Requalify@vimjax.org.