Sliding Fee Discount Program

RAHC offers a Sliding Fee Discount Program that may significantly reduce your healthcare costs at RAHC.  This program is available to all of our patients– insured or uninsured.

To apply for the Sliding Fee Discount Program:

  1. Fill out the entire application for the Sliding Fee Discount Program. List all members included on your tax return. The application must be signed by all adult patients. 
  2. Gather required proof of income. Please see the instructions on the application for more information.                                                
  3. Submit the completed application and proof of income by mail, in person or by fax to the number listed on the form.  
  4. We will contact you within 1-3 business days letting you know the outcome.  Applications submitted without proof of income will not be processed. 

*Patients wanting to be scheduled for family planning services are not required to have the Sliding Fee Discount in place.

Forms

  • Instructions and Application Fee Discount Program here.
  • Statement of Support (for patients with no income) here.
  • Income Verification Form (for patients that do not receive pay stubs) here
Outreach and Enrollment Specialist Justan Slagle processes applications for the Sliding Fee Discount Program.

Income Guidelines

Household SizeAnnual Income (200% FPL)
1 $24,280
2 $32,920
3 $41,560
4 $50,200
5 $58,840
6 $67,480
7 $76,120

Frequently Asked Questions

How do I apply?

Mail, fax or drop off the Application for the Sliding Fee Discount and proof of household income. 

How long is the discount good for?

Patients with income must reapply each year and every 6 months for patients with no income.

What do you count as income?

Wages, self-employment (profit), Social Security, alimony, retirement, investments, rental income, workers compensation and unemployment.

I work. What should I submit?

Submit 30 days worth of recent pay stubs in a row for all adults on your tax return. RAHC looks at income before taxes are taken out.

I have insurance. Can I apply?

Yes!  The only requirements are based on household size and income.

What doesn't get counted as income?

Minor income, child support, TANF or SNAP from Social Services, Supplemental Security Income, Veteran’s Disability and death benefits

What proof do you need for Social Security?

Please submit the current year Social Security Benefit letter.

Is this insurance?

No, this is not insurance.

Will my discount help me outside of RAHC?

Yes, but only with the places that have an agreement with RAHC.

How do I prove I don't have income?

Submit the Statement of Support form that is signed by the patient and someone helping the patient financially.

How will I know if I am approved?

The patient will receive a phone call within 1-3 business days and a letter with the discount card in the mail.

I have questions. Who should I call?

RAHC are available to answer any questions at (540) 464-8700, extension 7107, and in person.

Translate »