How to apply for financial assistance through MyLVHN

If you are uninsured or underinsured, you can apply for financial assistance from Lehigh Valley Health Network. Follow the steps below to submit your application through your MyLVHN account.

PDF instructions

To download PDF instructions, see links below.

Application Instructions

Self Declaration Instructions

What you’ll need to get started

  • Check whether you are eligible: Before you apply for financial assistance, check our income table to see if you are eligible based on your income and household size.
  • Fill out our application: If you are eligible, fill out the financial assistance program application, available in English or Spanish. Save the completed PDF to your desktop, tablet or mobile phone.
  • If you have no income: Additionally, if you have no income, you’ll need to fill out our self-declaration form. Save the completed PDF to your desktop, tablet or mobile phone.

How to upload your application

  1. Visit on your computer or open the MyLVHN app on your phone.
  2. In the menu, search “Financial Assistance” or look below the “Billing” heading and click on the link. You can also click here.
    Find Financial Assistance in the menu on MyLVHN
  3. On the Personal Info screen, you will select the patients who you would like to enroll in financial assistance.
    Select the patients who are applying for financial assistance in MyLVHN
  4. Next, on the Income screen, you will provide information about the size of your household and your income. If you have no income, you will upload the self-declaration form where indicated.
    Add the size of your household and income information.
  5. On the Documents screen, you will upload the completed PDF of the financial assistance application that you saved to your device.
    On this screen you will upload your completed application into MyLVHN.
  6. Finally, on the Review screen, you will review your entries and click “Submit” if everything looks correct. 
    Review your information and if everything looks correct, click "Submit"