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Sliding Fee Scale- Lincoln FQHC

SIU Center for Family Medicine - Lincoln
2017 SLIDING FEE SCALE for FINANCIAL ASSISTANCE
 
2017 ANNUAL FEDERAL POVERTY LEVEL (FPL) GUIDELINES
 FAMILY SIZE --
Members in Household
PERCENT OF FPL
2017
FPL
100% or Less
FQHC Level
0
101%-
155%
FQHC Level
1
156%-
170%
FQHC Level
2
171%-
185%
FQHC Level
3
186%-
200%
FQHC Level
4
Annual income displayed is highest possible in each category in order to qualify
1  $       12,060  $        12,060  $        18,693  $            20,502  $            22,311  $       24,120
2  $       16,240  $        16,240  $        25,172  $            27,608  $            30,044  $       32,480
3  $       20,420  $        20,420  $        31,651  $            34,714  $            37,777  $       40,840
4  $       24,600  $        24,600  $        38,130  $            41,820  $            45,510  $       49,200
5  $       28,780  $        28,780  $        44,609  $            48,926  $            53,243  $       57,560
6  $       32,960  $        32,960  $        51,088  $            56,032  $            60,976  $       65,920
7  $       37,140  $        37,140  $        57,567  $            63,138  $            68,709  $       74,280
8  $       41,320  $        41,320  $        64,046  $            70,244  $            76,442  $       82,640
Each add'l family member
> 8
 $         4,180  $           4,180  $           6,479  $              7,106  $              7,733  $          8,360
             
             
Sliding Fee Scale  Nominal Charge  Level 1 Level 2 Level 3 Level 4
MEDICAL/BEHAVIORAL   $5 $10 $15 $20 $25
DENTAL   $5 $25 $30 $50 $70