Sliding Fee Information

The sliding fee program allows us to reduce or "slide" the fees for the care of you or your family at PCHC. You can apply for the program if you need assistance to help you pay for your care.

Eligibility is based on family income and family size. Your bill always will be at least $25 for medical services; $40 for dental, vision and behavioral health services; and $15 for lab services. This minimum amount is due at the time of your visit, as well as payment for any other unpaid balances.

To apply for the sliding fee, please provide your most recent pay stubs for the last 30 days, current personal income tax return or an unemployment benefit statement.

 

SLIDING FEE SCALE - Based on 2017 Federal Poverty Guidelines

*If actual charges are less than amounts shown, patient pays lesser amount.

 

Federal Poverty Level <100% FPL 101-133% FPL 134-166% FPL 167-199% FPL >200% FPL
Slide Level A B C D E
Medical Sliding Fee          
Patient Pays* $25 $50 $75 $100 100% of charges
Dental Sliding Fee          
Patient Pays* $40 Greater of 25% or $40 Greater of 50% or $40 Greater of  75% or $40 100% of charges
Vision Sliding Fee          
Patient Pays* $40 $60 $70 $80 100% of charges
Behavioral Health Sliding Fee          
Patient Pays* $40 $60 $80 $120 100% of charges
Lab Visit Sliding Fee          
Patient Pays* $15 $25 $30 $40 100% of charges
           

 

         
           

2017 FEDERAL POVERTY GUIDELINES

MONTHLY INCOME

Number in Household A B C D E
1 $0-$1,005 $1,006-$1,340 $1,341-$1,675 $1,676-$2,010 >$2,011
2 $0-$1,353 $1,354-$1,804 $1,805-$2,256 $2,257-$2,707 >$2,708
3 $0-$1,702 $1,703-$2,269 $2,270-$2,836 $2,837-$3,403 >$3,404
4 $0-$2,050 $2,051-$2,733 $2,734-$3,417 $3,418-$4,100 >$4,101
5 $0-$2,398 $2,399-$3,198 $3,199-$3,997 $3,998-$4,797 >$4,798
6 $0-$2,747 $2,748-$3,662 $3,663-$4,578 $4,579-$5,493 >$5,494
7 $0-$3,095 $3,096-$4,127 $4,128-$5,158 $5,159-$6,190 >$6,191
8 $0-$3,443 $3,444-$4,591 $4,592-$5,739 $5,740-$6,887 >$6,888
9 $0-$3,791 $3,792-$5,055 $5,056-$6,320 $6,321-$7,584 >$7,585
10 $0-$4,139 $4,140-$5,519 $5,520-$6,901 $6,902-$8,281 >$8,282
11 $0-$4,487 $4,488-$5,983 $5,984-$7,482 $7,483-$8,978 >$8,979
12 $0-$4,835 $4,836-$6,447 $6,448-$8,063 $7,064-$9,675 >$9,676
           
           
           

YEARLY INCOME

Number in Household A B C D E
1 $0-$12,060 $12,061-$16,080 $16,081-$20,100 $20,100-$24,120 >$24,121
2 $0-$16,240 $16,241-$21,653 $21,654-$27,067 $27,068-$32,480 >$32,481
3 $0-$20,420 $20,421-$27,227 $27,228-$34,033 $34,034-$40,840 >$40,841
4 $0-$24,600 $24,601-$32,800 $32,801-$41,000 $41,001-$49,200 >$49,201
5 $0-$28,780 $28,781-$38,373 $38,374-$47,967 $47,968-$57,560 >$57,561
6 $0-$32,960 $32,961-$43,947 $43,948-$54,933 $54,934-$65,920 >$65,921
7 $0-$37,140 $37,141-$49,520 $49,521-$61,900 $61,901-$74,280 >$74,281
8 $0-$41,320 $41,321-$55,093 $55,094-$68,867 $68,868-$82,640 >$82,641
9 $0-$45,500 $45,501-$60,667 $60,668-$75,833 $75,834-$91,000 >$91,001
10 $0-$49,680 $49,681-$66,240 $66,241-$82,800 $82,801-$99,360 >$99,361
11 $0-$53,860 $53,861-$71,813 $71,814-$89,767 $89,768-$107,720 >$107,721
12 $0-$58,040  $58,041-$77,387  $77,388-$96,733 $96,734-$116,080 >$116,081