Participant Costs
PARTICIPANT FEES
The Healthy San Francisco Participant Fee is based on a "sliding scale." This means that the program will cost participants more or less depending on their place on the Federal Poverty Level. Simply put: Participants who earn less will pay less; participants who earn more will pay more. Use the chart below to determine where you may be on the Federal Poverty Level, or launch the interactive tool below:
|
Household Size
|
Your Monthly Family Income
| ||||
|---|---|---|---|---|---|
|
1
|
$0 - $904
|
$905 - $1,806
|
$1,807 - $2,708
|
$2,709 - $3,610
|
$3,611 - $4,515
|
|
2
|
$0 - $1,216
|
$1,217 - $2,430
|
$2,431 - $3,643
|
$3,644 - $4,857
|
$4,858 - $6,075
|
|
3
|
$0 - $1,527
|
$1,528 - $3,053
|
$3,054 - $4,578
|
$4,579 - $6,104
|
$6,105 - $7,630
|
|
4
|
$0 - $1,839
|
$1,840 - $3,676
|
$3,677 - $5,513
|
$5,514 - $7,350
|
$7,351 - $9,190
|
|
5
|
$0 - $2,151
|
$2,152 - $4,300
|
$4,301 - $6,448
|
$6,449 - $8,597
|
$8,598 - $10,750
|
| Quarterly Participant Fees (Paid Four Times a Year per Individual) | |||||
|
Amount per
Income Range: |
$0
|
$60
|
$150
|
$300
|
$450
|
IMPORTANT: Both the interactive tool and the income and payment charts on this page are designed to give users an idea of where they are likely to be on the Federal Poverty Level, and what their participant fee, paid four times a year, may be. A possibly different, but more accurate determination is made by the Eligibility Worker at the time an individual applies for the program.
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.
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% |
|---|---|---|---|
|
Primary
|
$0 |
$0
|
$10 |
|
Urgent
|
$0 |
$0
|
$20 |
|
Ancil/Rad/PT/OT
|
$0 |
$0
|
$20 |
|
Specialty
|
$0 |
$0
|
$20 |
|
Pharmacy
|
$0 |
$0
|
$5/$25 |
|
ER
|
$0 |
$25
|
$50 |
|
Same Day Surgery
|
$0 |
$0
|
$100 |
|
Inpatient
|
$0 |
$0
|
$200/admit |
|
Behavioral Health |
UMDAP1 |
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.
