Sliding Fee Program
Rural Health Care, Incorporated (RHCI) offers a sliding fee program to patients based on your household income and ability to pay.
Please review the documents below and complete the forms as instructed:
- Sliding Fee Program
- 2019 Sliding Fee Application
- 2019 Sliding Fee Scale
- Solicitud de Tarifas Variables para el 2019
- 2019 Escala de Tarifas Variables
- Zero Income Affidavit
- Declaracion Jurada de Cero Ingresos
Patients may submit the completed application with all required proof of income to any RHCI medical facility or mail to: 202 Island Drive, Suite 1, Fort Pierre, SD 57532.
If the application is missing information or is not signed, it will be denied. Incomplete applications will be considered void if all information is not received within 30 days.