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WOMEN'S HEALTH SECTION SLIDING FEE SCALE MONTHLY GROSS INCOME CABARRUS COUNTY HEALTH DEPARTMENT FAMILY PLANNING PROGRAM FOR USE IN FAMILY PLANNING AND MCH PROGRAMS 100% OF FAMILY ZERO PAY TWENTY PERCENT FORTY PERCENT SIXTY PERCENT POVERTY SIZE PAY PAY PAY PAY $552 1 $0 to $552 $553 to $690 $691 to $828 $829 to $965 $740 2 $0 to $740 $741 to $925 $926 to $1110 $1111 to $1295 $928 3 $0 to $928 $929 to $1160 $1161 to $1393 $1394 to $1625 $1117 4 $0 to $1117 $1118 to $1396 $1397 to $1675 $1676 to $1954 $1305 5 $0 to $1305 $1306 to $1631 $1632 to $1958 $1959 to $2284 $1493 6 $0 to $1493 $1494 to $1867 $1868 to $2122 $2123 to $2613 $1682 7 $0 to $1682 $1683 to $2102 $2103 to $2523 $2524 to $2943 $1870 8 $0 to $1870 $1871 to $2338 $2339 to $2805 $2806 to $3273 $2058 9 $0 to $2058 $2059 to $2573 $2574 to $3088 $3089 to $3602 $2247 10 $0 to $2247 $2248 to $2808 $2809 to $3370 $3371 to $3932 $2435 11 $0 to $2435 $2436 to $3044 $3045 to $3653 $3654 to $4261 $2623 12 $0 to $2623 $2624 to $3279 $3280 to $3935 $3936 to $4591 EIGHTY PERCENT FULL PAY PAY BEGINS $966 to $1102 $1103 $1296 to $1479 $1480 $1626 to $1856 $1857 $1955 to $2232 $2233 $2285 to $2609 $2610 $2614 to $2986 $2987 $2944 to $3362 $3363 $3274 to $3739 $3740 $3603 to $4116 $4117 $3933 to $4492 $4493 $4262 to $4689 $4870 $4592 to $5246 $5247 AFTER DETERMINING SLIDING SCALE PAY CATEGORY, FIND DOLLAR AMOUNT OF CHARGE ON APPROPRIATE SCHEDULE. INSTRUCTIONS: NOTE: NO CHARGES MAY BE ASSESSED IF PATIENT IS MEDICAID ELIGIBLE. SCHEDULE OF PATIENT (SELF-PAY OR PRIVATE PAY) CHARGES WOMEN'S PREVENTIVE HEALTH SERVICES (FAMILY PLANNING) 20% PAY 40% PAY 60% PAY 80% PAY $18.75 $37.50 $56.25 $75.00 FULL PAY WOMEN'S HEALTH SECTION 4/29/91 SERVICE Complete Physical (Initial or Annual) Extended Revisit (Revisit w/pelvic) Limited Revisit (Revisit w/o pelvic) Natural Family Planning (NFP Services)* $93.75 $ 7.85 $15.70 $23.85 $31.40 $39.25 $ 4.40 $ 8.80 $13.20 $17.60 $22.00 $ 8.00 $16.00 $24.00 $32.00 $40.00 * Natural Family Planning Services are those provided by a certified NFP Case Manager which are necessary to teach effective method usage. NFP services are NOT REIMBURSED BY MEDICAID and are billed to patients on a "per package" basis. A typical package of NFP services includes initial counseling and instruction and as many as three return sessions over the next two to three months, as well as necessary NFP supplies. Additional Charges may be assessed (at the discretion of the service provider) for subsequent visits exceeding those normally required to establish basic NFP proficiency.