E.A. Hawse Health Center Sliding Fee Scale

Household Members You pay 25% A You pay 50% B You pay 75% C You pay 100% 1 0 – 13,867 13,868 – 17,333 17,334 – 20,800 20,801 2 0 – 18,667 18,668 – 23,333 23,334 – 28,000 28,001 3 0 – 23,467 23,468 – 29,333 29,334 – 35,200 35,201 4 0 – 28,267 28,268 – 35,333 35,334 – 42,400 42,401 5 0 – 33,067 33,068 – 41,333 41,334 – 49,600 49,601 6 0 – 37,867 37,868 – 47,333 47,334 – 56,800 56,801 7 0 - 42,667 42,668 – 53,333 53,334 – 64,000 64,001 8 0 – 47,467 47,468 –59,333 59,334 –71,200 71,201 9 0 – 52,267 52,268 – 65,333 65,334 – 78,400 78,401

For family units of more than 9 members, add $4,800 for each additional family member.

Proof of your total family income is required for the EAHHC sliding fee scale. A copy of your federal tax return should be used as proof of income. Social Security letter, public assistance checks, alimony and child support agreements are all acceptable form of proof of income. Any dependents living in the household must be verified. Parents should provide a copy of their children's social security card or birth certificate.

Dental labs are not eligible for sliding fee. Dental labs are partials, dentures, plates, etc. Medical labs and X-rays are added to your office visit and are billed per the above schedule. Medical labs are any test such as blood work, urine, etc.

Example 1: If you are married and have two children, the total household members would be “4”. If you total household income is $21,000 per year, you would qualify for sliding scale “A” which means you pay 25% of your office visit charge for both Medical & Dental. You pay 100% for any dental labs and 25% for any medical labs.

Example 2: If you are single parent and have five children, the total household members would be “6”. If your total household income is $21,000 per year, you would qualify for sliding scale “A” which means you may pay 25% of your office visit charges for both Medical & Dental.

You pay 100% for any dental labs and 25% for any medical labs.

Example 3: If you are married and have three children, the total household members would be "5". If your total household income is $49,900 per year, you would not qualify for sliding fee which means you pay 100% of all charges for medical and dental.

Payment by Cash, Check or Credit Card when services rendered.