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Participants

Fees

As a Healthy San Francisco Participant, there are some fees you may need to pay.

PARTICIPANT FEES

Some Healthy San Francisco Participants pay a fee for their health coverage. The Healthy San Francisco Participant Fee is based on a “sliding scale.” This means that the program will cost Participants more or less depeding on their income. Simply put: Participants who earn less will pay less; Participants who earn more will pay more. Use the chart below to estimate, based on your family income, whether you may be required to pay a Participant Fee. The exact cost for you will be deterimined by a Certified Application Assistor at the time your application is completed.

Household Size0% - 100% of FPL101% - 200% of FPL201% - 300% of FPL301% - 400% of FPL401% - 500% of FPL**
1$0 - $973$974 - $1,945$1,946 - $2,918$2,919 - $3,892$3,893 - $4,863
2$0 - $1,311$1,312 - $2,622$2,623 - $3,933$3,934 - $5,244$5,245 - $6,555
3$0 - $1,650$1,651 - $3,299$3,300 - $4,948$4,949 - $6,597$6,598 - $8,246
4$0 - $1,988$1,989 - $3,975$3,976 - $5,963$5,964 - $7,950$7,951 - $9,938
5$0 - $2,326$2,327 - $4652$4,653 - $6,978$6,979 - $9,304$9,305 - $11,630
Quarterly Participant Fees (Paid Four Times a Year per Individual)
Amount per Income Range:$0 $60 $150 $300 $450

(based on April 2014 FPL, subject to change)
*FPL is the Federal Poverty Level
**As of January 1, 2015 HSF is not accepting new or renewing participants at or above 401% FPL

Upon enrollment in Healthy San Francisco, a Participant is eligible to receive services. Services may be received before the Participant has made their first quarterly Participant Fee, if applicable.

If after enrolling in the program your income or household size changes, please contact Healthy San Francisco Customer Service to determine if your Participation Fee should be decreased or increased. For example, the Participation Fee may decrease based on decreases in income/liquid assets and/or increases in the number of people in your household.

POINT OF SERVICE FEES

In addition to the Participant Fee, some program Participants may pay a Point of Service Fee to their clinic at the time services are received. For example, an 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:

ServiceGeneral Assistance / Homeless0% - 100% FPL101% - 400% FPL
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$25*
Same Day Surgery$0$0$100
Inpatient$0$0$200 / admit
Behavioral HealthUMDAP1UMDAP1UMDAP1

*If non-emergency and non-admission at SFGH.

If you have selected a DPH clinic and are unable to pay the point of service fee at the time of your visit, then check with your provider or clinic staff to see if you can and still need to be seen.

POINT OF SERVICE FEES at other Healthy San Francisco Medical Homes

Point of Service fees at Medical Homes associated with the SF Community Clinic Consortium (SFCCC), Kaiser Permanente, BAART, Brown & Toland Physicians, and Sister Mary Phillippa Health Center vary by clinic. Please contact the Medical Homes directly for a schedule of Point of Service Fees.

 1Behavioral health (mental health services and substance abuse services) Point of Service Fees will be consistent with the Uniform Methods of Determining Ability to Pay (UMDAP) outlined by the State of California. For more information on UMDAP fees, click here.