Fees
PROTECT YOURSELF FROM SCAMS
Scammers are getting more sophisticated in their efforts to get your money or private information. Be alert and protect yourself from being scammed, and know the following:
- Healthy San Francisco program will never call and ask you for money. If you receive a phone call like this, please call Healthy San Francisco Customer Service to report it: 415-615-4555.
- Healthy San Francisco only accepts personal checks and money orders as payments for quarterly participant fees.
- Healthy San Francisco doesn’t accept payments using:
- Credit cards
- Online bank transfers
- Venmo
- Zelle
- Other forms of payment.
If you have any questions or concerns about your participant fee or how to pay, please call Healthy San Francisco Customer Service for help at (415) 615-4555, Monday through Friday, 8:30am to 5:30pm.
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 depending 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 determined by a Certified Application Assistor at the time your application is completed.
| Participant’s Monthly Family Income | |||||
|---|---|---|---|---|---|
| Household Size | 0% – 100% of FPL | 101% – 200% of FPL | 201% – 300% of FPL | 301% – 400% of FPL | 401% – 500% of FPL |
| 1 | $0 – $1,255 | $1,256 – $2,510 | $2,511 – $3,765 | $3,766 – $5,020 | $5,021 – $6,275 |
| 2 | $0 – $1,704 | $1,705 – $3,408 | $3,409 – $5,110 | $5,111 – $6,816 | $6,817 – $8,517 |
| 3 | $0 – $2,152 | $2,153 – $4,304 | $4,305 – $6,455 | $6,456 – $8,608 | $8,609 – $10,759 |
| 4 | $0 – $ 2,600 | $2,601 – $5,200 | $5,201 – $7,800 | $7,801 – $10,400 | $10,401 – $13,000 |
| 5 | $0 – $3,049 | $3,050 – $6,098 | $6,099 – $9,145 | $9,146 – $12,196 | $12,197 – $15,242 |
| 6 | $0 – $3,497 | $3,498 – $6,994 | $6,995 – $10,490 | $10,491 – $13,988 | $13,989 – $17,484 |
| 7 | $0 – $3,945 | $3,946 – $7,890 | $7,891 – $11,835 | $11,836- $15,780 | $15,781 – $19,725 |
| 8 | $0 – $4,394 | $4,395 – $8,788 | $8,789 – $13,180 | $13,181 – $17,576 | $17,577 – $21,967 |
| Quarterly Participant Fees (Paid Four Times a Year per Individual) | |||||
| Quarterly Participant Fee Per Person | $0 | $60 | $150 | $300 | $450 |
(based on March 2024 FPL, subject to change)
*FPL is the Federal Poverty Level
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 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:
| Household Size | 0% – 100% of FPL | 101%-200% FPL | 201%-500% FPL |
|---|---|---|---|
| Primary | $0 | $10 | $10 |
| Urgent | $0 | $20 | $20 |
| Ancil / Rad / PT / OT | $0 | $20 | $20 |
| Specialty | $0 | $20 | $20 |
| Pharmacy | $0 | $5 / $25 | $5 / $25 |
| ER | $0 | $25* | $25* |
| Same Day Surgery | $0 | $100 | $100 |
| Inpatient | $0 | $200 / admit | $200 / admit |
| Behavioral Health | UMDAP1 | UMDAP1 | UMDAP1 |
*If non-emergency and non-admission at SFGH.
**Please check with your clinic at the time of service, as prices may vary based on services rendered. Fees are subject to change. No fees are assessed for homeless clients.
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, 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.