Co-Pay Rescue Program

Global Health Linkages, Inc. provides a free Co-Pay relief service that provides direct financial support to medically and financially qualified insured patients. Including those covered by government sponsored plans such as Medicare, Tricare, and Medicaid, for co-payments related to medical appointments.The Co-Pay Rescue Program relieves the financial burden to access high quality care.

To qualify for the Co-Pay Rescue Program you must have the following requirements listed below.

Eligibility Requirements

• Patients must have eligible and active insurance

• Patients must have a qualifying, verified diagnosis of the disease or condition for which they seek financial assistance

• Patients must reside and receive treatment in the United States

• Patient’s income must fall at or below 400% of the Federal Poverty Guideline (FPG) with consideration of the Cost of Living Index and number in the household.

To complete a Co-Pay Rescue Application online you must have a Google Mail (Gmail) account. Otherwise you can download an application form and bring a printed copy, along with the supporting information with you to any of the Community Behavioral Health centers.

Please have the following information ready to complete your application:

Before you start the form, please have scanned copies of your most recent versions of your supporting documents listed below ready.

  1. Proof of Income (employed/ unemployed)
  2. Proof of Address (US Citizen/ Lawful Permanent Resident)
  3. Proof of Insurance (Insurance card)

You will be asked if you can provide your:

    1. Annual Income
    2. Household Annual Income

Please note, all applicants are required to attest their income and that the application information provided is complete and accurate. Reported financial information may be verified by an audit, as deemed necessary by GHLI.

In order to successfully apply online, you must have electronic copies of the supporting information listed below.

Submit a Co-Pay Rescue Program Form – Google Form

GHLI Co-Pay Rescue Program Word – MS Word Format

GHLI Co-Pay Rescue Program – PDF Format