With this action, San Francisco Superior Court issued preliminary approval to the settlement. Notices about how to file a claim or object to the deal will be sent to affected patients within the next 45 days. Final court approval is scheduled for Jan. 11, 2007.

Going forward, uninsured patients with incomes of less than $250,000 per year will qualify for rates equivalent to the highest managed-care plan or a discount of 25 percent, whichever results in a lower bill.

The agreement essentially applies a charity-care policy adopted by CHW in May 2004 to benefit about 700,000 uninsured patients who received care at CHW hospitals after July 1, 2001. The initial settlement amount was estimated at about $228 million, according to court documents.

"Fear of a hospital bill should never prevent someone from seeking needed care at one of our hospitals," CHW officials said in a prepared statement about preliminary approval of the agreement. "That's why, in addition to our generous financial assistance policy, we also help people who are uninsured obtain health-care coverage through state and federally funded programs."

The class action was filed in October 2005 by the San Francisco law firm and attorneys for Scruggs Law Firm in Oxford, Miss., which successfully went after the tobacco industry.

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