Program Fees
There are two types of fees that may be required after you join Healthy San Francisco: A Participant Fee, paid four times a year, and a Point-of-Service Fee.
Participant Fees for Employees
The Healthy San Francisco Participant Fee depends on your family size, household income, and the amount of money your employer paid to the City on your behalf. If your income is below a certain amount you may not be required to pay a Participant Fee at all.
The chart below provides an idea of what your participant fee, paid four times a year, might be; it includes the 75% discount.
|
Household Size
|
Your Monthly Family Income
| |||
|---|---|---|---|---|
|
1
|
$0 - $2,600
|
$2,601 - $3,467
|
$3,468 - $4,334
|
$4,335+
|
|
2
|
$0 - $3,500
|
$3,501 - $4,667
|
$4,668 - $5,834
|
$5,835+
|
|
3
|
$0 - $4,400
|
$4,401 - $5,867
|
$5,868 - $7,334
|
$7,335+
|
|
4
|
$0 - $5,300
|
$5,301 - $7,067
|
$7,068 - $8,834
|
$8,835+
|
|
5
|
$0 - $6,200
|
$6,201 - $8,267
|
$8,268 - $10,334
|
$10,335+
|
|
Participant
Fee - Paid four times a year |
$0
|
$75
|
$113
|
$150
|
IMPORTANT: The payment charts on this page are designed to give employees an idea of what their participant fee, paid four times a year, may be. A possibly different, but more accurate determination is made by the Application Assistor at the time an individual applies for the program.
This payment information is intended for individuals applying for Healthy San Francisco through a deposit made by their employer. If you are interested in joining Heathy San Francisco as an individual - independent of your employer - please visit the general Participant section.POINT OF SERVICE FEES
In addition to the Participant Fee, program participants may pay a small Point of Service Fee to their clinic at the time services are received. For example, a small additional fee will be paid each time a participant visits a physician, emergency room, or picks up a prescription. The amount of the Point of Service Fee depends on the Medical Home and household income of the program participant. If a participant's income is below a certain amount, that participant will not pay a Point of Service Fee for most services.
NOTE: The 75% employee discount does not apply to Point of Service Fees.
SF DEPARTMENT OF PUBLIC HEALTH (DPH) POINT OF SERVICE FEES
Medical Homes associated with the San Francisco Department of Public Health (DPH) will collect Point of Service fees from Healthy San Francisco Participants according to the following schedule:
|
Service |
Gvmt Assisted/ |
0 - 100% |
101 - 500% |
501% + |
|---|---|---|---|---|
|
Primary
|
$0 |
$0
|
$10 |
$20 |
|
Urgent
|
$0 |
$0
|
$20 |
$50 |
|
Ancil/Rad/PT/OT
|
$0 |
$0
|
$20 |
$50 |
|
Specialty
|
$0 |
$0
|
$20 |
$50 |
|
Pharmacy
|
$0 |
$0
|
$5/$25 |
$25/$50 |
|
ER
|
$0 |
$25
|
$50 |
$100 |
|
Same Day Surgery
|
$0 |
$0
|
$100 |
$200 |
|
Inpatient
|
$0 |
$0
|
$200/admit |
$350 |
|
Behavioral Health |
UMDAP1 |
UMDAP |
UMDAP |
UMDAP |
SF COMMUNITY CLINIC CONSORTIUM (SFCCC) POINT OF SERVICE FEES
Point of Service fees at Medical Homes associated with the SF Community Clinic Consortium (SFCCC) vary by clinic. Please contact SFCCC clinics directly for a schedule of Point of Service fees.
1Behavioral health Point of Service fees will be consistent with the Uniform Methods of Determining Ability to Pay (UMDAP) outlined by the State of California.
