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TODU GUAM FOUNDATION · PATIENT RESOURCES

About our
Sliding Fee Discount
Program

We believe everyone deserves great healthcare, no matter what they can afford.
Our program helps lower the cost of your visits
based on your family size and how much your family makes.

Program Overview

See what the discount covers, how it works with insurance, and when to renew.

Lower Costs for Primary Care

The program lowers the cost of primary care visits at the TGF Health & Wellness Center for eligible patients. Your discount is based on your household size and gross household income.

With or Without Insurance

Eligible patients can use the program with or without health insurance. If you have insurance, we bill your plan first. The discount may then apply to your copay or other remaining charges you owe.

Renew Every 6 Months

Submit a new application every 6 months to keep receiving the discount. If your household size or income changes between renewals, update your information with TGF.

Calculate Your Estimated Discount

Select your household size to see the annual income limits and what you may pay.

Tier A

$50 Nominal Fee

Annual household income

At or below $15,960

Highest discount

Tier B

20% of bill

Annual household income

Up to $19,950

High discount

Tier C

40% of bill

Annual household income

Up to $23,940

Moderate discount

Tier D

60% of bill

Annual household income

Up to $27,930

Standard discount

Tier E

80% of bill

Annual household income

Up to $31,920

Base discount

Private Pay

100% of bill

Annual household income

Over $31,920

Standard rates apply

Income limits are based on annual gross (before-tax) household income.

For each additional person beyond 8, the income limits increase by:

  • Tier A: $5,680
  • Tier B: $7,100
  • Tier C: $8,520
  • Tier D: $9,940
  • Tier E: $11,360

How to Apply

  1. 1. Download the Application

    Get the Sliding Fee Discount Program application.

    View Application (PDF)

  2. 2. Complete the Application

    Fill in your household and income details and gather the documents that apply to you.

  3. 3. Submit the Application

    Submit your completed application and proof of income at our Tamuning clinic or by mail.

    Contact Us

Application Checklist

Use this checklist to complete Step 2.

1. Income Sources

Review the items below and provide proof for those that apply to your household.

  • Help from relatives and non-relatives
  • Business profits
  • Veterans’ benefits
  • Sick pay
  • Social Security income
  • Workers’ compensation income
  • Pension or retirement income
  • Alimony received
  • Child support received
  • Unemployment compensation
  • Disability or Supplemental Security Income (SSI)
  • Net rental income
  • Royalties received
  • Investment income (including rent, interest, dividends, or annuity payments)
  • TANF or SNAP eligibility letter
  • Common deductions (federal or state taxes, Social Security, savings bonds, and union dues)

2. Acceptable Proof

Proof is required for applicable income. Attach copies of the documents that apply to the income you reported.

  • 1099 statements for the prior year
  • Paycheck stubs from the last 30 days
  • Income tax return for the most recent year Include the entire return with all worksheets attached.
  • Unemployment verification (benefit statement)
  • Court documents for alimony, child support, or both
  • Agency letter stating the benefit level (for TANF or SNAP recipients)
  • Benefit letter (for SSI and Social Security recipients)

Questions about the Sliding Fee Program?

We can help you check if you qualify or figure out what to bring.

Contact TGF