The Healthy Families Program
The Healthy Families Program is a low-cost insurance program that provides health, dental and vision coverage to children who do not have insurance and do not qualify for no-cost Medi-Cal.
When you enroll your child in the program, you will choose the health, dental and vision insurance plans. These insurance plans pay most of your child’s costs for visits to doctors, dentists or specialists. The insurance plans also contract with clinics, laboratories, pharmacies and hospitals for your child’s health care.
Who can apply?
Parents, legal guardians, stepparents, foster parents or caretaker relatives may apply for insurance for a child. Only the income of the parent(s) will be considered. If you are a legal guardian, stepparent, foster parent or caretaker relative who lives with a child, your income will not be used to qualify the child for the Program. If you are age 18 or younger, you may qualify to apply for your own insurance if you meet the income requirements. Newborns and children under one year old may qualify for Healthy Families if their family meets the income requirements.
How much does it cost to cover my child?
You pay a low monthly premium, which is determined by family size, family income, and the health plan you choose.
Where do I get an application for Healthy Families?
Call toll-free, (800) 880-5305, 8 a.m. to 8 p.m., Monday through Friday.
Phone operators can give you a list of Certified Application Assistants (CAAs) in your area. These CAAs can help you fill out the application at no cost to you.
Who qualifies?
• Children up to their 19th birthday
• Families with income at or below 250 percent of the Federal Income Guidelines
• Children without employer-sponsored health insurance in the last three months
• Children not eligible for no-cost Medi-Cal
• Children who are U.S. Citizens, nationals, or eligible qualified immigrants
• Children who live in California
How do I determine my eligibility for Healthy Families?
To determine your eligibility you will need to know the number of family members living in your household and the net family income (after deductions). There are several deductions for childcare if both parents are working, as well as court-ordered child support and/or alimony. You can call toll-free to get the application form, which details the deductions (800) 880-5305.
How do I apply for Healthy Families?
Call to get the application form: (800) 880-5305. Fill out the application form and mail it in the envelope provided. A complete application should have all the information requested and copies of all required documents attached. Be sure to include your first month’s Healthy Families insurance premium. If you need help filling out your application, call toll-free (800) 880-5305. You can also be given a list of CAAs in your area that can help you with your application at no cost to you.
How long will it take to process my child’s application?
Once Healthy Families receives a complete application, they will process it within 10 calendar days to determine eligibility. You will be notified by letter and will also receive a welcome telephone call. The letter gives the date on which insurance coverage will begin for each enrolled child. The first day of coverage begins 10 days from the date Health Families determines that your child qualifies for the program.
How do I pay my monthly insurance premiums?
Mail the first month’s premium payment with your application. Make your payment to “Healthy Families Program.” Once your child is enrolled in Healthy Families, you will receive a bill in the mail each month. Your payment will be due on the 20th day of the month. You may also pay in cash at any Rite Aid store. Call toll-free at (800) 748-3243 for the Rite Aid store nearest you.
Are there any additional costs?
Yes. In addition to the monthly insurance premiums, you pay a co-payment of $5 at the time of service. Some services (such as preventive care services) are free. No individual charge will exceed $5. The maximum co-payment amount per benefit year that you pay for health care services is $250 per family. The benefit year begins July 1 and ends June 30 (no matter when you enroll). Keep all your receipts for co-payments. If you reach the maximum $250 in co-payments for the benefit year, inform your health insurance plan, and you will not have to make any more co-payments for health care services until the next benefit year begins.
Selecting insurance plans
The county in which your children live determines what plans (health, dental and vision plans) are available. Occasionally, a plan may reach the maximum number of applicants in a county and it will not accept new applicants. In general, the benefits are the same in all the Healthy Families plans.
Each insurance plan administers its benefits differently. For more information about plan benefits, and what’s available in your county, call toll-free (800) 880-5305.
What are the citizenship and immigration requirements for the Healthy Families Program?
Your child must be a U.S. citizen, U.S. non-citizen national or eligible qualified immigrant. Questions about citizenship and immigration apply to the children—not the parents.
Annual open enrollment period
Each year, you can change health and dental insurance plans for your child. This process is called “open enrollment.” It is held from April 15 to May 31 of each year. Healthy Families will mail you information in early April. This will describe the open enrollment process. If you choose new insurance plans during open enrollment, all enrolled children in the household will be transferred to the new insurance plans. The transfer will be effective on July 1.
Annual eligibility review
Each year, you will be asked to confirm that your child is still qualified for the Healthy Families Program. You will be notified by mail of the Annual Eligibility Review process. You will receive a notice about 60 calendar days before the end of the child’s anniversary date in the Healthy Families Program.