Sliding Fee Scale
Henderson Wellness Clinic offers discounted medical care to patients who are uninsured and have low income. The amount a patient pays is based on the federal income levels. Each year the federal government sets a Federal Poverty Line (FPL) and new income levels that qualify patients for discounted care. The income levels are based on a patient’s gross income (how much money you make each year before taxes are taken out).
How Do I Apply?
In order to qualify you will need to meet the following requirements listed below and fill out the sliding scale fee application.
- Call 855.955.5428 ext 809 to become a patient
- Submit your application and proof of income
- Email: Info@hendersonwellnessclinic.org
- Fax: 844.389.0835
- Postal mail: Henderson Wellness Clinic, Attn. Billing Department 1490 W Sunset Rd Suite 120. Henderson, NV 89014
- If you are not able to send your application and documentation, please bring them to your next appointment.
Once all documents have been reviewed, you will be informed of the sliding fee based on gross annual income and household size. If you have questions about the sliding fee scale procedure, please contact the billing team at 855.955.5428 ext 809.
|Household Annual Gross Income||HWC Sliding Fee||Ryan White maximum charge per calendar year (January 1 to December 31)|
|Equal to or below 100% of the federal poverty line||$5||No charges permitted|
|101 – 125% of the federal poverty line||$10||$10 per visit with no more than 5% of gross annual income in a 12 month period|
|126 – 150% of the federal poverty line||$15||$15 per visit with no more than 5% of gross annual income in a 12 month period|
|151 – 175% of the federal poverty line||$20||$20 per visit with no more than 5% of gross annual income in a 12 month period|
|176 – 200% of the federal poverty line||$25||$25 per visit with no more than 5% of gross annual income in a 12 month period|
|201 – 300% of the federal poverty line||100% of visit fee||100% per visit with no more than 7% of gross annual income in a 12 month period|
|More than 300% of the federal poverty line||100% of visit fee||100% per visit with no more than 10% of gross annual income in a 12 month period|
How Do I Qualify?
To qualify for the Henderson Wellness Clinic Sliding Fee Scale, Ryan White Sliding Fee Scale or Ryan White maximum charges, you must bring proof of your “household” gross annual income. A “household” includes legal children, a civil union partner or married spouse, and legal dependents. Annual gross income includes salary, unemployment benefits, disability or social security benefits, investment income or other sources of income that support the household. You should bring proof of all of the household income for yourself and everyone in your household.
The following documents are can be used for proof of income:
- Most recent tax return
- 2-3 most recent pay stubs from employer, no older than three months
- Most recent W-2 or 1099
- Letter from employer stating cash earnings that is signed by your employer or supervisor
- Letter from the Social Security Administration documenting your SSI or SSDI benefits
- Letter from the Social Security Administration documenting that you are ineligible for government benefits
- Letter detailing unemployment benefits from your state unemployment office
- Military Leave and earnings statement
- Notarized letter stating you have no source of income signed by you