Eligibility – Sliding Fee Scale

If you or any members of your family are uninsured, you may qualify for reduced-cost health services through our Sliding Fee Scale. To see if you are eligible for discounted services, please use the annual income guidelines below:

2010 FEDERAL POVERTY GUIDELINES & SLIDING FEE SCALE

		LEVEL A (< 100%)	LEVEL B (101% - 149%)		LEVEL C (150% - 174%)		LEVEL D (175% - 199%)		LEVEL E (200%)
Family Size *	Income Presented	Less than	Minimum	Maximum	Minimum	Maximum	Minimum	Maximum	Minimum

1	Annual	$10,830	$10,831	$16,137	$16,138	$18,844	$18,845	$21,552	$21,553

2	Annual	$14,570	$14,571	$21,709	$21,710	$25,352	$25,353	$28,994	$28,995

3	Annual	$18,310	$18,311	$27,281	$27,282	$31,859	$31,860	$36,437	$36,438

4	Annual	$22,050	$22,051	$32,855	$32,856	$38,367	$38,368	$43,880	$43,881

5	Annual	$25,790	$25,791	$38,427	$38,428	$44,875	$44,876	$51,322	$51,323

6	Annual	$29,530	$29,531	$44,000	$44,001	$51,382	$51,383	$58,765	$58,766

7	Annual	$33,270	$33,271	$49,572	$49,573	$57,890	$57,891	$66,207	$66,208

8	Annual	$37,010	$37,011	$55,145	$55,146	$64,397	$64,398	$73,650	$73,651

Patient Pays		$20.00	25%		50%		75%		100.0%
Updated 12/31/10

* Add $3,740 for each additional person

HOW TO USE THIS SCALE:

Determine the number of members in a Family Unit.
Determine ALL income supporting the family + ALL sources of income (i.e., paystubs, alimony, social security, retirement, etc.)
Find the number of family members in Column 1 ("Size of Family Unit").
Determine the range in which the patient's "Family Income" falls.
The column in which the patient's "Family Income" falls indicates the percentage of Sliding Fee Scale discount.

Questions? Want to apply for Sliding Fee Scale

The eligibility guidelines may not be correct for all situations. To find out what programs you qualify for and/or to apply, please contact a Benefit Advocate at (317) 474-0148 or email jjacobs@windrosehealth.net. A Benefit Advocate will respond within 24-48 hours.