Children's Health Insurance Program (California)

More: State Children's Health Insurance Programs 

California Healthy Families

Healthy Families, the State Children's Health Insurance Program in California, provides health insurance for children under age 19 who do not qualify for Medi-Cal and cannot afford private coverage. The plan offers low-priced health, dental, and vision coverage to uninsured children of working families.

Eligibility Requirements
Healthy Families is a low cost health insurance program for children living in California under the age of 19 with family income between 0-300% of FPL. They must have been without employer-sponsored health insurance for the last three months. They cannot be eligible or enrolled in Medi-Cal and they must meet citizenship or immigration guidelines. Healthy Families is also available to children born to mothers enrolled in the AIM Program, which provides health insurance coverage to those children who are not enrolled in the no-cost full scope Medi-Cal Program or employer-sponsored health insurance. The family income must be within the Healthy Families Guidelines. Minors without parents and their children can qualify on their own. Legal guardians, foster parents or step-parents are exempt from income guidelines.

Waiting Periods
You can join Healthy Families at anytime, but must wait three months after coverage ends from an employer-sponsored plan.

Covered Services and Benefits
California Healthy Families covers the following medically necessary services:

• Physician Services - Office, home visits, Allergy testing and treatment
• Preventative Care - Health exams, family planning services, prenatal care, vision and hearing testing, immunizations, STD testing, health education services, annual pap smear exams and confidential HIV/AIDS counseling and testing
• Maternity care
• Hospital services - Inpatient/Outpatient
• Prescription Drugs - 30 day supply, 90 day maintenance drugs
• Lab and X-ray services
• Durable Medical Equipment
• Mental Health
• Dental & Vision Care
• Alcohol and drug abuse
• Physical, Occupational, Speech Therapy
• Emergency and Non-emergency medical transportation
• Emergency health care services
• Home health care
• Skilled nursing care

Health Plan Options
Several community health plan companies offer the Healthy Families program. There are several plans to choose from for the county in which you reside. Plan options will vary geographically throughout California and will have different benefit levels.

Premium Payments, Co-Payments and Coinsurance
Healthy Family premiums vary depending on the health plan you select and the insurance company you have selected to manage your health care. Usually, the monthly premium for children is determined by income category, which includes family size, family income, and the health plan you choose. Monthly premiums range between $4 and $17 for each child, up to a maximum of $51 for all children in a family enrolled in the Healthy Families Program. Members also pay a co-payment (usually $5) when they go to the doctor or get other services. Some services such as preventive health care are free. No individual charge will exceed $5 for children's benefits.

The maximum co-payment amount per benefit year (that is from July 1 to June 30 of a year) that you pay for health care services is $250 per family. It is important to keep all your receipts for the co-payments you make at the time of receiving health care services. Notify your health plan if you reach the maximum $250 for the benefit year of coverage. You will not have to make any more $5 co-payments for health care services until the next benefit year of coverage.

Program Length, Enrollment and Renewal
You will be asked to complete a renewal form every 12 months to determine if qualification guidelines are still being met and your premiums could be adjusted if necessary. A renewal form will be mailed to you 60 days prior to the 12 month renewal time. Through the renewal notice, the health plan verifies your family size and income. You can change plans during open enrollment, which is from April 15th to May 31st of each year. If you choose new insurance plans during open enrollment, all children in the household will be transferred to the new insurance plans. Coverage in the new plan will start on July 1st.

California Healthy Families Contact Information

P.O. Box 138005
Sacramento, CA 95813-8005
800-880-5305

Healthy Families Website

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