Partnership Community Health Center, Inc. (PCHC) uses a sliding fee schedule based on the federal poverty guidelines established by the U.S. government.

2019 Monthly Income Ranges for Federal Poverty Level (FPL) Calculation

Household Size

100% and below FPL

101 – 133% FPL

134 – 166% FPL

167-200% FPL

1

0 – 1,041

1,042 – 1,384

1,385 – 1,728

1,729 – 2,082

2

0 – 1,409

1,410 – 1,874

1,875 – 2,339

2,340 – 2,818

3

0 – 1,778

1,779 – 2,364

2,365 – 2,951

2,952 – 3,555

4

0 – 2,146

2,147 – 2,854

2,855 – 3,562

3,563 – 4,292

5

0 – 2,514

2,515 – 3,344

3,345 – 4,173

4,174 – 5,028

6

0 – 2,883

2,884 – 3,834

3,835 – 4,786

4,787 – 5,765

7

0 – 3,251

3,252 – 4,324

4,325 – 5,397

5,398 – 6,502

8

0 – 3,619

3,620 – 4,813

4,814 – 6,008

6,009 – 7,138

*** HOUSEHOLDS WITH MORE THAN 8 PERSONS ADD $360.00 FOR EACH ADDITIONAL PERSON***

100% Discount assessed to all charges with NOMINAL FEE requested

SLIDING FEES

Fee Tier (Circle One)

NOMINAL FEE

Sliding Fee Tier 1

Sliding Fee Tier 2

Sliding Fee Tier 3

Flat Fee Exam

$20 * No more than $20 will be requested for a single date of service

$30.00

$50.00

$80.00

Fee For Non-Exam Services

30%

40%

50%

Charges and Calculated Sliding Fee for N9on-Exam services will vary based on the procedure or additional services being performed. If you qualify for reduced cost services, Partnership Community Health Center (PCHC) will notify you prior to your appointment with an estimated cost. The estimated cost is subject to change based on services done at your appointment. Payment is due at the time of your appointment.

 

**For families with more than 8 persons, add $338.0 for each person to calculate the poverty ranges**

Each year existing patients (and new patients) need to bring in proof of income (check stubs), picture ID, and current income tax forms.

Check stubs = 1 month | Tax returns = 1 year | Proof of no income = 3 months