708.596.5177SLIDING FEE DISCOUNT PROGRAM
Family Christian Health Center offers discounted services based on the Federal Poverty Level Guidelines. Levels are based upon family size and annual income verified by: check stubs, social security, tax returns, certified letter, etc.
You must complete an application form and bring in the verification papers for the program.
Donate for this programe
Medical/BHC/Dental 2022 Sliding Fee Schedule
| Level 1 | Level 2 | Level 3 | Level 4 | Level 5 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Poverty Level: | At or < 100% | 133% | 150% | 175% | 200% | |||||
| Family Size | Minimum | Maximum | Minimum | Maximum | Minimum | Maximum | Minimum | Maximum | Minimum | Maximum |
| 1 | $ - | $13,590.00 | $13,591.00 | $18,075.00 | $18,076.00 | $20,385.00 | $21,386.00 | $23,783.00 | $23,784.00 | $27,180.00 |
| 2 | $- | $18,310.00 | $18,311.00 | $24,352.00 | $24,353.00 | $27,465.00 | $27,466.00 | $32,043.00 | $32,044.00 | $36,620.00 |
| 3 | $- | $23,030.00 | $23,031.00 | $30,630.00 | $30,631.00 | $38,230.00 | $38,231.00 | $40,303.00 | $40,304.00 | $46,060.00 |
| 4 | $- | $27,750.00 | $27,751.00 | $36,908.00 | $36,909.00 | $46,065.00 | $46,066.00 | $48,563.00 | $48,564.00 | $55,500.00 |
| 5 | $- | $32,470.00 | $32,471.00 | $43,185.00 | $43,186.00 | $53,900.00 | $53,901.00 | $56,823.00 | $56,824.00 | $64,940.00 |
| 6 | $- | $37,190.00 | $37,191.00 | $49,463.00 | $49,464.00 | $61,735.00 | $61,736.00 | $65,083.00 | $65,084.00 | $74,380.00 |
| 7 | $- | $41,910.00 | $41,911.00 | $55,740.00 | $55,741.00 | $69,571.00 | $69,572.00 | $73,343.00 | $73,344.00 | $83,820.00 |
| 8 | $- | $46,630.00 | $46,631.00 | $62,018.00 | $62,019.00 | $77,406.00 | $77,407.00 | $81,603.00 | $81,604.00 | $93,260.00 |
| For families/households greater than 8, add $4,720 per each additional person. | $4,720.00 | $4,720.00 | $4,720.00 | $4,720.00 | $4,720.00 | |||||
| Nominal Fee for Services per visit (Medical / Behavior Health) | $25.00 | $35.00 | $45.00 | $55.00 | $100.00 | |||||
| Nominal Fee for Services per visit (Dental) | $25.00 | $35.00 | $45.00 | $55.00 | $100.00 | |||||
*** Some dental fees may be partially discounted. These fees may include but are not limited to dentures, partials, flipper and lab fees.
Note: If patient is unable to provide evidence to support their income and/or family size, they may be considered self-pay and not sliding fee discount eligible; therefore payment is expected at the time of service
and will be collected at time of visit. However, if patient is homeless or is referred to us from a transitional housing agency, FCHC may fully write-off charges on a case-by-case basis.
