Co-Pay Chart
Co-Pay Chart |
||||||||
|
Family Fee Scale
(Family Co-Pay Per Day) |
||||||||
|
Income
Range Monthly |
Family 2 Family
CoPay with 1 child |
Family Size 3
Family CoPay |
Family Size 4
Family CoPay |
Family Size 5 +
Family CoPay |
||||
|
With 1
Child |
With 2
or more |
With 1
Child |
With 2
or more |
With 1
Child |
With 2
or more |
|||
|
0
|
899
|
$0.00
|
$0.00
|
$0.00
|
$0.00
|
$0.00
|
$0.00
|
$0.00
|
|
900
|
999
|
$2.50
|
$2.50
|
$3.00
|
$2.50
|
$2.75
|
$2.25
|
$2.75
|
|
1,000
|
1,099
|
$3.25
|
$3.25
|
$3.75
|
$2.75
|
$3.25
|
$2.50
|
$3.00
|
|
1100
|
1199
|
$4.00
|
$4.00
|
$4.50
|
$3.25
|
$3.75
|
$2.75
|
$3.25
|
|
1200
|
1299
|
$4.50
|
$4.50
|
$5.00
|
$4.00
|
$4.50
|
$3.00
|
$3.50
|
|
1300
|
1399
|
$5.00
|
$5.00
|
$5.50
|
$5.00
|
$5.50
|
$3.50
|
$4.25
|
|
1400
|
1499
|
$6.50
|
$5.50
|
$6.25
|
$5.50
|
$6.25
|
$4.25
|
$4.75
|
|
1500
|
1599
|
$7.50
|
$6.00
|
$6.75
|
$6.00
|
$6.75
|
$5.00
|
$5.75
|
|
1600
|
1699
|
$8.50
|
$6.50
|
$7.50
|
$6.50
|
$7.50
|
$6.00
|
$6.75
|
|
1700
|
1799
|
$9.50
|
$7.00
|
$8.00
|
$7.00
|
$8.00
|
$6.75
|
$7.50
|
|
1800
|
1899
|
$10.00
|
$8.50
|
$9.50
|
$7.50
|
$8.50
|
$7.50
|
$8.50
|
|
1900
|
1999
|
$10.50
|
$9.50
|
$10.50
|
$8.00
|
$9.00
|
$8.00
|
$9.00
|
|
2000
|
2099
|
$11.00
|
$10.50
|
$11.50
|
$8.50
|
$9.50
|
$8.50
|
$9.50
|
|
2100
|
2199
|
$12.00
|
$10.50
|
$11.50
|
$9.00
|
$10.00
|
$9.00
|
$10.00
|
|
2200
|
2299
|
$12.00
|
$11.50
|
$12.50
|
$10.50
|
$11.50
|
$9.50
|
$10.50
|
|
2300
|
2399
|
$12.50
|
$13.50
|
$11.25
|
$12.25
|
$9.75
|
$10.75
|
|
|
2400
|
2499
|
$12.50
|
$13.50
|
$12.25
|
$13.25
|
$10.25
|
$11.25
|
|
|
2500
|
2599
|
$13.50
|
$14.50
|
$12.25
|
$13.25
|
$10.75
|
$11.75
|
|
|
2600
|
2699
|
$13.50
|
$14.50
|
$13.25
|
$14.50
|
$12.25
|
$13.25
|
|
|
2700
|
2799
|
$13.25
|
$14.50
|
$13.25
|
$14.25
|
|||
|
2800
|
2899
|
$14.25
|
$15.50
|
$14.25
|
$15.75
|
|||
|
2900
|
2999
|
$14.25
|
$15.50
|
$16.25
|
$17.25
|
|||
|
3000
|
3099
|
$15.25
|
$16.50
|
$18.25
|
$19.25
|
|||
|
3100
|
3199
|
$15.25
|
$16.50
|
$20.25
|
$21.25
|
|||
|
3200
|
3299
|
$20.25
|
$21.25
|
|||||
|
3300
|
3399
|
$22.25
|
$23.25
|
|||||
|
3400
|
3499
|
$22.25
|
$23.25
|
|||||
|
3500
|
3599
|
$24.25
|
$25.25
|
|||||
|
3600
|
3699
|
$24.25
|
$25.25
|
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