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We are an authorized Enrollment Entity for the State of California Healthy Families
and Medi-Cal for Children and Expectant Mothers, (EE - 89481) We are not a State
agency.
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Frequently Asked Questions (FAQ) |
How do I know if my children are eligible for the Healthy Families Program?
Your children must fall under the following criteria:
- Live in California
- Between the ages of 0– 18 years of age up to their 19th birthday
- Be without Employer health insurance in the last three months
- Not eligible for or are not enrolled in no-cost Medi-Cal
- Must meet citizenship or immigration requirements
- Fall within the Healthy Families Guidelines
How soon after I apply will I know if my children are eligible?
Healthy Families will send you a letter within 10 business days after they receive your application.
What are some of the benefits (services) children can get from Healthy Families?
- Hospital care when it is medically necessary
- Care from doctors, including surgeons
- Prescription drugs
- Well Child services to prevent disease
- Family planning (birth control)
- Mental health care
- Alcohol and drug treatment service
- Physical, speech and occupational therapy
- Lab and X-ray services
- Dental Services
- Eye care
How much would my premiums be under The Healthy Families Program?
Members pay a premium (payment) each month depending on income levels. It can cost from $4 to $15 per child and no more than $45 for all Healthy Families eligible children in a family.
Some services are free, though members may pay a co-payment (usually $5) when they go to the doctor and for other services.
How can I save money with The Healthy Families Program?
You can choose the Community Provider Plan. This plan offers the same services as the more expensive plans, but is less expensive. You may also save by paying premiums three months at a time, or by paying with
electronic fund transfer.
Do I get to choose my children's health plan?
Yes, you may choose a health plan of your choice. Please note that the health plans available may vary depending on the county you live in.
How do I pick a health plan?
The plans are similar but not exactly the same. You may request information about the health plans available in your county.
What if my child doesn't qualify for The Healthy Families Program? Is there other health coverage I can get?
- If your income is below the limit for Healthy Families, you may qualify for no-cost Medi-Cal. Healthy Families can send your application to the county office nearest you to find out if you qualify for Medi-Cal.
- If your income is above the limit for Healthy Families, there may be other programs you can access.
Does my child have to be a U.S. citizen to join Healthy Families?
Children eligible for the Healthy Families Program must meet the following requirements:
- A U.S. citizen. or
- A United States citizen national (non U.S citizen), or
- A qualified immigrant (requirement for children only)
I am self-employed. How do I show proof of income?
You can use your last Federal Tax Return (1040 form) and Schedule C or a Profit/Loss Statement.
What income does not count?
You can't count income from these sources:
- SSI/SSP payments
- Foster care payments
- CalWORKS (AFDC replacement)
- General Relief payments
- Grants/scholarships used for school
- Earnings from a job of a child under 14 years old or who attends school
- Some government benefit payments
- Loans
- College work study payments
Please check with your local county welfare office for more detailed information.
Can my children join The Healthy Families Program even if I don't live in California?
Yes, but your children (the children you are applying for) must live in California.
Do children have to live in the same home as the applicant in order to enroll?
No, but only the income of the household biological parents is used to determine eligibility.
Do I have to stay in the same plan year after year?
No, once a year there is an Open Enrollment period.
What if I don't like the plan we are enrolled in? Can I switch plans?
Yes, you may change plans during the first three months after joining Healthy Families or during Open Enrollment.
What if I have a disagreement with The Healthy Families Program or my health plan?
You may appeal a decision asking for it to be reconsidered. The following are situations where an appeal would be appropriate:
- Eligibility – when application for enrollment has been denied;
- The date benefit coverage should start;
- Disenrollment – being removed from the Healthy Families Program
The Healthy Families Program and your health plan have certain steps you must follow in order to appeal a decision.
Do I apply just once, or do I have to re-apply every year?
The Healthy Families Program will ask you to complete an Annual Eligibility Review form (AER) once a year. This is used to determine if you child is still eligible to continue under the program. If you meet the program requirements you will be able keep the coverage for another year until the next AER.
Can I sign up my newborn baby?
Yes, you may apply as early as three months before the baby is due.
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