Sliding Fee Information

Promise Community Health Center ensures that no one will be denied access to health services due to their inability to pay.

Our sliding fee program allows us to reduce or "slide" the fees for the care of you or your family. 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 2018 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
           

Note: Promise's family planning services operate under a separate sliding-fee scale. For more information, visit the family planning page.

 

2018 FEDERAL POVERTY GUIDELINES

MONTHLY INCOME

Number in Household A B C D E
1 $0-$1,012 $1,013-$1,349 $1,350-$1,686 $1,687-$2,023 >$2,024
2 $0-$1,372 $1,373-$1,829 $1,830-$2,286 $2,287-$2,743 >$2,744
3 $0-$1,732 $1,733-$2,309 $2,310-$2,886 $2,887-$3,463 >$3,464
4 $0-$2,092 $2,093-$2,789 $2,790-$3,486 $3,487-$4,183 >$4,184
5 $0-$2,452 $2,453-$3,269 $3,270-$4,086 $4,087-$4,903 >$4,904
6 $0-$2,812 $2,813-$3,749 $3,750-$4,686 $4,687-$5,623 >$5,624
7 $0-$3,172 $3,173-$4,229 $4,230-$5,286 $5,287-$6,343 >$6,344
8 $0-$3,532 $3,533-$4,709 $4,710-$5,886 $5,887-$7,063 >$7,064
9 $0-$3,892 $3,893-$5,189 $5,190-$6,486 $6,487-$7,783 >$7,784
10 $0-$4,252 $4,253-$5,669 $5,670-$7,086 $7,087-$8,503 >$8,504
11 $0-$4,612 $4,613-$6,149 $6,150-$7,686 $7,687-$9,223 >$9,224
12 $0-$4,972 $4,973-$6,629 $6,630-$8,286 $8,287-$9,943 >$9,944
           
           
           

ANNUAL INCOME

Number in Household A B C D E
1 $0-$12,140 $12,141-$16,187 $16,188-$20,233 $20,234-$24,280 >$24,281
2 $0-$16,460 $16,461-$21,947 $21,948-$27,433 $27,434-$32,920 >$32,921
3 $0-$20,780 $20,781-$27,707 $27,708-$34,633 $34,634-$41,560 >$41,561
4 $0-$25,100 $25,101-$33,467 $33,468-$41,833 $41,834-$50,200 >$50,201
5 $0-$29,420 $29,421-$39,227 $39,228-$49,033 $49,034-$58,840 >$58,841
6 $0-$33,740 $33,741-$44,987 $44,988-$56,233 $56,234-$67,480 >$67,481
7 $0-$38,060 $38,061-$50,747 $50,748-$63,433 $63,434-$76,120 >$76,121
8 $0-$42,380 $42,381-$56,507 $56,508-$70,633 $70,634-$84,760 >$84,761
9 $0-$46,700 $46,701-$62,267 $62,268-$77,833 $77,834-$93,400 >$93,401
10 $0-$51,020 $51,021-$68,027 $68,028-$85,033 $85,034-$102,040 >$102,041
11 $0-$55,340 $55,341-$73,787 $73,788-$92,233 $92,234-$110,680 >$110,681
12 $0-$59,660  $59,661-$79,547  $79,548-$99,433 $99,434-$119,320 >$119,321