E.A. Hawse Health Center Sliding Fee Scale

Household Members

You pay 10% B

You pay 20% C

You pay 40% D

You pay 60% E

You pay 80% F

You pay 100%

1

0 – 10,400

10,401 – 12,999

13,000 – 15,598

15,599 – 18,197

18,198 – 20,796

20,797

2

0 – 14,000

14,001 – 17,499

17,500 – 20,998

20,999 – 24,497

24,498 – 27,996

27,997

3

0 – 17,600

17,601 – 21,999

22,000 – 26,398

26,399 – 30,797

30,798 – 35,196

35,197

4

0 – 21,200

21,201 – 26,499

26,500 – 31,798

31,799 – 37,097

37,098 – 42,396

42,397

5

0 – 24,800

24,801 – 30,999

31,000 – 37,198

37,199 – 43,397

43,398 – 49,596

49,597

6

0 – 28,400

28,401 – 35,499

35,500 – 42,598

42,599 – 49,697

49,698 – 56,796

56,797

7

0 - 32,000

32,001 – 39,999

40,000 – 47,998

47,999 – 55,997

55,998 – 63,996

63,997

8

0 – 35,600

35,601 –44,499

44,500 – 53,398

53,399 – 62,297

62,298–71,196

71,197

9

0 – 39,200

39,201 – 48,999

49,000 – 58,798

58,799 – 68,597

68,598 –78,396

78,397

For family units of more than 9 members, add $3,600 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 chlid 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.

All Dental labs are billed at 100%. Dental labs are partials, dentures, plates, etc. Medical labs 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 “C” which means you pay 20% of your office visit charge for both Medical & Dental. You pay 100% for any dental labs and 20% 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 “ B” which means you may pay 10% of your office visit charges for both Medical & Dental.

You pay 100% for any dental labs and 10% for any medical labs.

Example 3: If you are married and have three children, the total household members would be "6". If your total household income is $21,000 per year, you would qualify for sliding fee "B" whcih means you pay 10% of your office visit charge for both Medical and Dental. You pay 100% for any dental labs and 10% for any medical labs.

If you are on sliding fee, your charges for that day are due when you check out with the front office unless arrangements have been made for a payment plan. You may pay by check, cash, or credit card.