Eligibility and Enrollment

Help for the Uninsured

If you are uninsured and cannot afford the prescription medicine you need, you may be able to have your prescriptions filled at no cost through Welvista.

You must be uninsured.

You may not have Medicaid, Medicare, VA Health Benefits, Affordable Care Act or Private Health Insurance. You can have Family Planning or Healthy Check up through the Medicaid Program.

You must live in South Carolina.

We require you to provide proof of residency.

You must provide proof of income for each income-earning person in your home.

These include: wages, unemployment benefits, workers’ compensation, pension, social security, disability, child support and alimony. If no one in your home has income, please contact us for a No Income Form or download and print the form here. If you need help completing the form, call 803-933-9183.

The total gross household income in your home must be at or below the amounts below (based on 2018 Federal Poverty Guidelines).

Persons in Family or Household Monthly Gross Income Yearly Gross Income
1 $2,023 $24,280
2 $2,743 $32,920
3 $3,463 $41,560
4 $4,183 $50,200
5 $4,903 $58,840
6 $5,623 $67,480
7 $6,343 $76,120
8 $7,063 $84,760
For each additional person, add: $720 $8,640

Submit an Application

There is NO application fee and all medications received from Welvista are completely FREE. Medications are mailed by the US Postal Service to the patient’s home. Applications are active for one year, unless patient receives health insurance during that time.

If you qualify for all of the items listed above, you may download and fill out the application form!

Please ensure you fill out the entire form and provide us with all the required documents so that your application may be fully processed in a timely manner.

Application

Employer Statement of Income Form

No Household Income Form

Forms in Spanish

Información Sobre el Paciente

Declaración de Ingresos del Empleador

Formulario de Ingresos Nulos

Preguntas Frecuentes

 

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Help us provide hope and wellness for the uninsured.

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