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Healthy
Families application form
Parents/rightful guardians must complete a Healthy Families application
form. This is an important step in getting coverage for the child[ren].
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Parents may request an application
form by calling the Care1st Health Plan Member Services Department
at 1.800.605.2556. |
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If assistance is needed to complete the
application we can also provide parents with the names of Certified
Application Assistants in their area who will help at no cost. |
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Parents wishing to enroll their children
with Care1st must write in plan code 1028 in Section A of the
form. |
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Completed applications must include copies
of all required documents and the first month’s premium
and be mailed in the appropriate supplied envelope to the Healthy
Families Program. |
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The Healthy Families Program will process
the submitted application within 14 calendar days. Those determined
to be eligible will receive a letter of notification outlining
the effective date of coverage. A welcome phone call will also
be made notifying parents of their child[ren]’s acceptance. |
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Once eligibility is established, the child[ren]
will be covered for 12 months. |
Got Questions?
Questions regarding your application submission should be directed
to the Healthy Families Program Administrator at 1.800.880.5305.
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Member
Services
1-800-605-2556 |
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Healthy
Families Program Administrator
1-800-880-5305 |
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