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Sliding Fee Scales

Notice to patients: Community Health Centers of the Rutland Region serves all patients regardless of income or insurance status. Discounts for essential services provided by CHCRR, including discounts for pharmacy services provided by CHCRR or one of the contracted pharmacies, are offered on a sliding fee scale basis adjusted for family size and income. Front desk personnel can assist you in applying, or you may apply directly by calling the clinic and asking for the patient outreach coordinator.

Medical & Behavioral Health Sliding Fee Scale

100% Discount

$10 Nominal Fee
to be collected at time of service

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,140
2 $0—$16,460
3 $0—$20,780
4 $0—$25,100
5 $0—$29,420
6 $0—$33,740
7 $0—$38,060
8 $0—$42,380

For each additional person
add $4,320

75% Discount

Greater of $20 Nominal Fee
or 25% of the charge to be collected at time of service

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,141—$16,389
2 $16,461—$22,221
3 $20,781—$28,053
4 $25,101—$33,885
5 $29,421—$39,717
6 $33,741—$45,549
7 $38,061—$51,381
8 $42,381—$57,213

For each additional person
add $4,320

50%Discount

Greater of $20 Nominal Fee
or 50% of the charge to be collected at time of service

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,390—$20,638
2 $22,222—$27,982
3 $28,054—$35,326
4 $33,886—$42,670
5 $39,718—$50,014
6 $45,550—$57,358
7 $51,382—$64,702
8 $57,214—$72,046

For each additional person
add $4,320

25%Discount

Greater of $20 Nominal Fee
or 75% of the charge collected at time of service

If your income falls between

Family Size Federal
Poverty Level
1 $20,639—$24,280
2 $27,983—$32,920
3 $35,326—$41,560
4 $42,671—$50,200
5 $50,015—$58,840
6 $57,359—$67,480
7 $64,703—$76,120
8 $72,047—$84,760

For each additional person
add $4,320

Pharmacy Sliding Fee Scale

100% Discount

Acquisition cost
+ pharmacy dispensing fees
+ $2.50 admin fee

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,140
2 $0—$16,460
3 $0—$20,780
4 $0—$25,100
5 $0—$29,420
6 $0—$33,740
7 $0—$38,060
8 $0—$42,380

For each additional person
add $4,320

75% Discount

Acquisition cost
+ pharmacy dispensing fees
+ $5.00 admin fee

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,141—$16,389
2 $16,461—$22,221
3 $20,781—$28,053
4 $25,101—$33,885
5 $29,421—$39,717
6 $33,741—$45,549
7 $38,061—$51,381
8 $42,381—$57,213

For each additional person
add $4,320

50%Discount

Acquisition cost
+ pharmacy dispensing fees
+ $7.50 admin fee

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,390—$20,638
2 $22,222—$27,982
3 $28,054—$35,326
4 $33,886—$42,670
5 $39,718—$50,014
6 $45,550—$57,358
7 $51,382—$64,702
8 $57,214—$72,046

For each additional person
add $4,320

25%Discount

Acquisition cost
+ pharmacy dispensing fees
+ $10.00 admin fee

If your income falls between

Family Size Federal
Poverty Level
1 $20,639—$24,280
2 $27,983—$32,920
3 $35,326—$41,560
4 $42,671—$50,200
5 $50,015—$58,840
6 $57,359—$67,480
7 $64,703—$76,120
8 $72,047—$84,760

For each additional person
add $4,320

Dental Sliding Fee Scale

100% Discount

$10 Nominal Fee collected at time of service.  Lab fees additional cost to patient.

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,140
2 $0—$16,460
3 $0—$20,780
4 $0—$25,100
5 $0—$29,420
6 $0—$33,740
7 $0—$38,060
8 $0—$42,380

For each additional person
add $4,320

75% Discount

Greater of $25 nominal or 25% collected at time of service. Lab fees additional cost to patient.

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,141—$16,389
2 $16,461—$22,221
3 $20,781—$28,053
4 $25,101—$33,885
5 $29,421—$39,717
6 $33,741—$45,549
7 $38,061—$51,381
8 $42,381—$57,213

For each additional person
add $4,320

50%Discount

Greater of $25 nominal or 50% collected at time of service. Lab fees additional cost to patient.

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,390—$20,638
2 $22,222—$27,982
3 $28,054—$35,326
4 $33,886—$42,670
5 $39,718—$50,014
6 $45,550—$57,358
7 $51,382—$64,702
8 $57,214—$72,046

For each additional person
add $4,320

25%Discount

Greater of $25 nominal or 75% collected at time of service. Lab fees additional cost to patient

If your income falls between

Family Size Federal
Poverty Level
1 $20,639—$24,280
2 $27,983—$32,920
3 $35,326—$41,560
4 $42,671—$50,200
5 $50,015—$58,840
6 $57,359—$67,480
7 $64,703—$76,120
8 $72,047—$84,760

For each additional person
add $4,320

Applying for Sliding Fee

When you come for your appointment to apply for sliding fee scales, please bring the following information with you:

  • Birth Certificate
  • Driver’s license
    with your picture on it or another photo ID showing your current address
  • Proof of Residency
    (postmarked envelope, postcard or envelope, driver’s license issued within the last 6 months, utility bill, lease/rent receipt, property tax records)
  • Proof of income
    including documentation for all wages earned (pay stubs for 4 consecutive pay periods or your tax return from the previous year), social security, worker’s comp, veteran’s benefits, military pay, child support/alimony, income from rent and interest/dividends from bank accounts, pensions and annuities.

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