Sliding Fee Schedule
Discounted fees are available. The amount depends on family income and size. Obtain your application at the front office, or you can call 208-879-4351 to request form and one will be mailed to you.
Sliding Fee Application: The discounts apply to all services offered at the Challis Area Health Center facility in Challis, including primary care, laboratory, and x-ray. However, the sliding fee discounts do not apply to any services performed away from the Challis Area Health Center facility.
Sliding Fee Requirements: When applying for the sliding fee program, patient identification and address must be provided. Acceptable methods include a valid driver’s license, state ID card, employment, or other picture ID. A Social Security Number is needed for the application form and a copy of the SSN card is necessary. A copy of a Social Security card or birth certificate is required for under aged dependents. A copy of the prior year’s income tax return for each individual living in the household is required to verify income. If employment has changed since the filing of that return, copies of the last three months’ paycheck stubs or payroll records showing year-to-date earnings are required. If the applicant has had no income for three months or more, this must be verified through some other official agency records, i.e., bank records, or by written statement from a landlord or other person outside the household having knowledge of the applicant’s financial situation.
If You Feel You May Qualify: Please complete a Financial Assistance/Sliding Fee Program Application and return it to the Challis Area Health Center office. If you wish to apply the sliding fee to your current visit, you will need to return the completed application and submit your verification data with five (5) working days of the visit.
Approval for Sliding Fee Program: You will be notified in writing when your application has been processed regarding your eligibility.
Terms of Sliding Fee Program: Once approved, your application will be valid for a term of twelve (12) months unless there is a substantial change in household makeup or income. It is your responsibility to reapply when the current eligibility period has expired.
Income Thresholds for Sliding Fee Program Discounts: The 2016 annual income & monthly income threshold tables are shown below. You are required to pay your co-pay amount each time you visit the Challis Area Health Center, Inc. regardless of the type of service you are receiving (primary care, laboratory, x-ray or a combination of services). If you do not pay your co-pay each date of service your Sliding Fee Scale discount will not be applied to that date of service.
If you have any questions, contact the Challis Area Health Center at (208)-879-4351 Ext 1
* Please ask to speak to Sara Jones *
Federal Poverty Income Guidelines & Sliding Fee Scale
Federal Poverty Guidelines (FPG) <100% 101% to 125% 126% to 150% 151% to 175% 176% to 200% Above 200%
Household Size Annual Annual Annual Annual Annual
1 $0-$11,770 $11,771-$14,713 $14,714-$17,655 $17,656-$20,598 $20,599-$23,540 $23,541
2 $0-$15,930 $15,931-$19,913 $19,914-$23,895 $23,896-$27,878 $27,879-$31,860 $31,861
3 $0-$20,090 $20,091-$25,113 $25,114- $30,135 $30,136-$35,158 $35,159-$40,180 $40,181
4 $0-$24,250 $24,251-$30,313 $30,314-$36,375 $36,376-$42,438 $42,439-$48,500 $48,501
5 $0-$24,410 $24,411-$35,513 $35,514-$42,615 $42,616-$49,718 $49,719-$56,820 $56,821
6 $0-$32,570 $35,571-$40,713 $40,714-$48,855 $48,856-$56,998 $56,999-$65,140 $65,141
7 $0-36,730 $36,731-$45,914 $45,915-$55,095 $55,096-$64,278 $64,279-$73,460 $73,461
8 $0-$40,890 $40,891-$51,113 $51,114-$61,335 $61,336-$71,558 $71,559-$81,780 $81,782
***Additional: $4,160 $5,200 $6,240 $7,280 $8,320
Reduction/Sliding Fee 100% 80% 60% 40% 20% 0%
Fee Nominal Charge $25.00 Minimum Fee $35.00 Minimum Fee $45.00 Minimum Fee $55.00 Minimum Fee $65.00 N/A
If your income falls between the incomes per household, you may be eligible for the Sliding Fee Scale Program. Please contact the Challis Area Health Center at 208-879-4351 ext. 1 to make an appointment with our Enrollment Specialist.
The Challis Area Health Center, Inc provides essential health services regardless of the patient’s ability to pay.