Sources of Income
The following are approved ways to verify your household income:
- Unemployment Compensation
- Workmen’s Compensation
- Welfare Benefits
- Social Security
- Supplemental Security Income
- Veteran’s Benefits
- Survivor Benefits
- Earnings from need—based Employment programs
- Regular Contributions from persons not living in household
*Any other income not included in this list.
Proof of Income
Proof of income is required to qualify for the sliding fee program and may include the following:
- Previous year’s federal tax filing
- The most recent 1-3 paycheck stubs
- Employer earning statement
- Federal and/or State award letters
- Copies of benefit checks
- Statement of Benefits
Refer to Sliding Fee Program Brochure below.
- Once approved for the sliding fee program, all qualifying charges from a medical, dental, and/or behavioral health visit will receive a sliding fee discount.
- Medical visits include all services provided on-site at Missouri Ozarks Community Health with the exception of certain tests and procedures not routinely performed or deemed not medically necessary by a Missouri Ozarks Community Health provider. Limited labs, x-rays and other services will be included in the sliding fee nomi- nal charge. Please see a member of our staff for assistance with pricing for services not included in the visit nominal charge.
- Each appointment with a Missouri Ozarks Community Health provider, regardless of the frequency or reason for the visit, will have a nominal charge due at the time of service.
- Consult with our Pharmacy for discounted prescription pricing.
Missouri Ozarks Community Health’s sliding fee discount schedule is based on the federal poverty guidelines updated annually in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2). The sliding fee discount schedule is updated annually based on changes to the federal poverty guidelines by the CFO and CEO with approval from the Missouri Ozarks Community Health Board of Directors.
In order to qualify for the sliding fee program, patients must complete the sliding fee program application paperwork and provide the appropriate proof of income. Patients cannot be seen on the sliding fee program until they have completed their sliding fee paperwork and have provided proof of income. Enrollments in the sliding fee program will be renewed annually.
* Revised Sliding fee program effective 5/18/2017Download PDF [Sliding Fee Program Brochure]