Healthy San Francisco (HSF)

Healthy San Francisco Participant Fees

Depending on your household size and income, you may be required to pay a Healthy San Francisco Participant fee four times per year. Your Employer’s City Option contribution will be applied to Healthy San Francisco to support your enrollment and participation in the program, and provide you with a discount on the quarterly Healthy San Francisco Participant Fee. The discount is available for 6 months after your Employer’s contribution to City Option, so we encourage you to enroll in Healthy San Francisco as soon as possible before your discount expires.

The chart below is designed to give you an idea of what the quarterly Participant fee may be with the discount applied.

Employee's Monthly Family Income
Household Size0-100% of FPL*101% - 200% of FPL*201% - 300% of FPL*301% - 400% of FPL*401% - 500% of FPL*501%+ of FPL*
1$0-$1,005.00 $1,006.00 - $2,010.00 $2,011.00 - $3,015.00 $3,016.00 -$4,020.00$4,021.00-$5,025.00$5,026.00+
2$0 - $1,354.00$1,355.00 - $2,707.00$2,708.00 - $4,060.00$4,061.00-$5,414.00$5,415.00-$6,767.00$6,768.00+
3$0 - $1,702.00$1,703.00 - $3,404.00$3,405.00-$5,105.00$5,106.00-$6,807.00$6,808.00 -$8,509.00$8,510.00+
4$0 - $2,050.00$2,051.00- $4,100.00$4,101.00 - $6,150.00$6,151.00 - $8,200.00$8,201.00 -$10,250.00$10,251.00+
5$0 - $2,399.00$2,400.00 - $4,797.00$4,798.00 - $7,195.00$7,196.00 - $9,594.00$9,595.00 -$11,992.00$11,993.00+
Quarterly Participant Fees After Employer Discount
Amount per Income Range$0 $0$0$75$113$169

*FPL is the Federal Poverty Level. Chart is based on April 2017 FPL and subject to change.

In addition to the Participant fees, you may also pay Point of Service Fees when you receive health care services after you enroll. For example, an additional fee may be paid each time you visit a physician or emergency room, or pick up a prescription.  The amounts of the Point of Service Fees depend on your Medical Home and household income.