There is Help Available to Pay for your Health Care:
The Community Health Net’s Sliding Fee Discount Program
| FAMILY SIZE |
Discount A $25.00* |
Discount B $35.00 | Discount C $45.00 | Discount D $55.00 | Full Fee 100% |
|---|---|---|---|---|---|
| 1 Person: Annually | $0 - $15,960.00 | $15,960.01 - $21,386.40 | $21,386.41 - $26,653.20 | $26,653.21 - $31,920.00 | $31,920.01 + |
| 1 Person: Weekly | $0 - $307.00 | $307.01 - $411.00 | $411.01 - $513.00 | $513.01 - $614.00 | $614.01 + |
| 2 People: Annually | $0 - $21,640.00 | $21,640.01 - $28,997.60 | $28,997.61 - $36,138.80 | $36,138.81 - $43,280.00 | $43,280.01 + |
| 2 People: Weekly | $0 - $416.00 | $416.01 - $558.00 | $558.01 - $695.00 | $695.01 - $832.00 | $832.01 + |
| 3 People: Annually | $0 - $27,320.00 | $27,320.01 - $36,608.80 | $36,608.81 - $45,624.40 | $45,624.41 - $54,640.00 | $54,640.01 + |
| 3 People: Weekly | $0 - $525.00 | $525.01 - $704.00 | $704.01 - $877.00 | $877.01 - $1,051.00 | $1,051.01 + |
| 4 People: Annually | $0 - $33,000.00 | $33,000.01 - $44,220.00 | $44,220.01 - $55,110.00 | $55,110.01 - $66,000.00 | $66,000.01 + |
| 4 People: Weekly | $0 - $635.00 | $635.01 - $850.00 | $850.01 - $1,060.00 | $1,060.01 - $1,269.00 | $1,269.01 + |
| 5 People: Annually | $0 - $38,680.00 | $38,680.01 - $51,831.20 | $51,831.21 - $64,595.60 | $64,595.61 - $77,360.00 | $77,360.01 + |
| 5 People: Weekly | $0 - $744.00 | $744.01 - $997.00 | $997.01 - $1,242.00 | $1,242.01 - $1,488.00 | $1,488.01 + |
| 6 People: Annually | $0 - $44,360.00 | $44,360.01 - $59,442.40 | $59,442.41 - $74,081.20 | $74,081.21 - $88,720.00 | $88,720.01 + |
| 6 People: Weekly | $0 - $853.00 | $853.01 - $1,143.00 | $1,143.01 - $1,425.00 | $1,425.01 - $1,706.00 | $1,706.01 + |
| 7 People: Annually | $0 - $50,040.00 | $50,040.01 - $67,053.60 | $67,053.61 - $83,566.80 | $83,566.81 - $100,080.00 | $100,080.01 + |
| 7 People: Weekly | $0 - $962.00 | $962.01 - $1,289.00 | $1,289.01 - $1,607.00 | $1,607.01 - $1,925.00 | $1,925.01 + |
| 8 People: Annually | $0 - $55,720.00 | $55,720.01 - $74,664.80 | $74,664.81 - $93,052.40 | $93,052.41 - $111,440.00 | $111,440.01 + |
| 8 People: Weekly | $0 - $1,072.00 | $1,072.01 - $1,436.00 | $1,436.01 - $1,789.00 | $1,789.01 - $2,143.00 | $2,143.01 + |
Community Health Net is a Federally Qualified Health Center (FQHC)
As a FQHC, we are able to offer a discount on services based on income and family size.
We use the above table to determine your discount eligibility.
(This table can be located at https://aspe.hhs.gov/poverty-guidelines)
What services are included in the program?
• Primary care visits at Community Health Net
• Behavioral health visits at Community Health Net
• Eye clinic visits at Community Health Net
• Dental care visits at Community Health Net
• Prescriptions filled at Community Health Net (see Pharmacy for restrictions)
What services are NOT included in the program?
• Hospital Visits, Hospital Services, Nursing Homes
• Imaging facilities (x-rays, CT, MRI, etc.)
• Laboratories (ACL, etc.)
• Some dental procedures: partials, dentures, crowns, or items produced at an offsite lab
Sliding Fee Discounts can be determined by using any of the following (or combination):
• Federal Income Tax forms
• W-2’s
• Consecutive Pay stubs
• Unemployment Benefits
• Social Security Benefits
• Self-declaration options are also available
Recertification is required annually or when changes to family size or income occur. Once you have been approved for the Sliding Fee Discount Program, you will remain active in the program for one year from application approval.