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.