Emergency Assistance

Notice of POLICY – Requirements for Assistance

To ensure the request for assistance is handled properly, please submit the following supporting documentation with your referral/submission. The referral must be on the facility stationary, a copy of the admission record or physician statement, proof of identity (copy of identification card) and please indicate if the patient is hospitalized, or provide the perspective date of discharge?

Please note the MEMRA association does not have funding in place to assist individuals unable or having difficulty paying their housing and/or utilities services. The MEMRA association is designed to assist individuals with a valid medical emergency.

All Applications requesting medical equipment, certain medical supplies, pharmacy prescriptions, emergency room services, office visits, burial assistance, hospital procedures/tests, the following documentation is required; A referral and/or statement from a Licensed Medical Facility, and or Licensed Medical Professional which may include a Physician Signature. The following documents may be required when submitting your application for assistance.

  • City/State/Federal Government Agency
  • Income & Earnings Statements
  • Medical Records/Facility Statement
  • Medical/Pharmacy Prescription
  • Other (specify)
  • Other Income & Earnings Statements
  • Physician Statement
  • Proof of Identity (additional requirements for out-of-state)
  • Utilities/Bills/Statements

Guidelines

  • Equipment:
    Equipment purchased or donated to those needing support and unable to pay the out-of-pocket expenses (that has no medical benefits or support), low income, on a fixed income, etc., and requires no re-payment to the association. In which no funds are requested only equipment.
  • Relief:
    When the association takes action and provides aid/support at a time of need when a valid medical emergency / hardship occurs and the individual or family has no medical benefits. Request amount. $150.00 or less.
  • Assistance:
    The relief association provides assistance to individuals or a family in need when a valid emergency medical hardship or devastation occurs. The association can provide assistance to help assist and support with the occurrence up to the amount of $300.00.
  • Special Request:
    The medical association may provide assistance based on a temporary situation to an individual or family that is experiencing a medical hardship, out of work temporarily and returning back after a short/long disability. Special request applies to liens and workers compensation cases. Referrals must be submitted in writing to our Medical Review Department.

    Medical professionals or providers, for a summary of coverage, maximum amount allowed, exclusions and limitations please refer to our medical review department, this form provides a detailed list of the types of procedures and/or test that are acknowledged for assistance.

It is the Organization’s desire that its responsibilities be discharged with the utmost integrity and in a manner that fulfills its tax exempt purposes.

It is also the goal of the Board of Directors responsibility to oversee the organization operations as well as all emergency request(s) handled in an efficient and timely manner maximizing all resources, but more importantly, to protect the Organization from assuming undue risks and liabilities and to comply with all laws and IRS requirements governing charitable organizations.

Emergency Services

  • Emergency Room & Urgent Care

Medical Offices

  • Doctors Appointments,
    Co-payments, Outpatient Services

CNA / Aide

  • In-home services for medical care with light housekeeping, meals & medications

Cremation

  • For Burial Assistance, must have no means of support or burial insurance or assistance

F/U-Up Visit

  • Appointments and medical services
 Pharmacy Prescriptions

  • Medications, Prescription re-fills & Supplies

Equipment / Supplies

  • Purchase, Rental or Donated for Charitable Purposes

Travel Expenses

  • For Medical Appointments Only, (types of transportation may vary depending on need or disability)

Burial Assistance

  • Proof of family relationship & residency (unless homeless)

Professional / Clinical

  • Licensed Nurse, LSW, Therapist, etc.

Please Note:
Please be advised that various requests may be placed on a waiting list, approved with restrictions or denied based on budget restraints. Referrals/requests are reviewed on a case by case circumstance(s).

IDENTIFICATION POLICY

ID REQUIRMENTS … All Applicants Must Present Photo ID When Requesting Assistance!

When scheduling your appointment, you must use exactly the same name as shown on the primary identification document that you will present at the test center.

  • A current and valid photo ID (for example a driver’s license);
  • or a current utility bill, bank statement, government check or paycheck that shows name & address;
  • or another government document that shows name & address (for example a voter card).

Acceptable forms of IDENTIFICATION include the following:

  • Identification card with Photo
  • Driver’s license with Photo
  • Military ID
  • Passport
  • Any Federal, state or local government-issued ID
  • Employer issued photo ID card
  • Social Security Card
  • Bank ID Card Acceptable with Photo & Signature

A second form of ID may be required as proof of identity.