Health Insurance Enrollment
Assistance

We offer Outreach and Enrollment Coordinators, or Certified Application Counselors (CACs), who are trained and able to help individuals who are seeking health coverage options through the Marketplace or Medicaid. We are eager to assist you with this process.

These outreach and enrollment services are FREE to you and your family.

In order for our coordinators to assist you in applying for coverage, you must meet certain citizenship requirements (some non-citizens may apply), be an Ohio resident, have a social security number and meet certain financial requirements.

Documentation needed

  • Birth certificate
  • Social security card
  • Verification of address & citizenship
  • Valid driver’s license or passport
  • Verification of income and resources
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How to Qualify for Sliding Fee Scale

Total household income must not exceed 200% of the Federal Poverty Guidelines
Proof of household income is required, such as income tax return, copies of your last pay stubs, W-2 or proof of government assistance.
Program details and an application can be obtained by clicking on the forms below or from the registration staff.

Sliding Fee Scale Application Form

Individuals without insurance are welcome to become patients at Five Rivers Health Centers, as we accept patients regardless of their ability to pay. Discounts are offered to members of households with combined income of 200% and below of the Federal Poverty Level. To determine if you qualify, complete the form (either online or print) prior to your first appointment. Our Outreach & Enrollment Specialists will be happy to assist you with this process.

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Contact Us

If you need assistance, please give us a call at one of the locations below.

Center for Women's Health
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Center for Women's Health

161 Wyoming St., Dayton, OH 45409
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Family Health Center
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Family Health Center

2261 Philadelphia DR., Dayton, OH 45406
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Greene County Health Center
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Greene County Health Center

360 Wilson Dr., Xenia, OH 45385
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Medical Surgical Health Center
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Medical Surgical Health Center

725 S. Ludlow St., Dayton, OH 45402
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Samaritan Health Center
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Samaritan Health Center

921 S. Edwin C. Moses Blvd., Dayton, OH 45417
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