Healthy Families Insurance

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Low Cost Dental Insurance For Other Family Members

California Healthy Families Income Guidelines

Children Health Plans in California Healthy Families

HealthyFamilies-ca-gov.net Application

We are an authorized Enrollment Entity for the State of California Healthy Families and Medi-Cal for Children and Expectant Mothers, (EE - 85691). Though we are not a State Agency, we assist with the enrollment of children and expectant mothers in either the Healthy Families or Med-Cal Programs. As an authorized Enrollment Entity we provide live assistance with online enrollment in these government programs. This assistance is free of charge.

Welcome to
HealthyFamilies-ca-gov.net!
California Healthy Families is low cost insurance for children and teens. It provides health, dental and vision coverage to children who do not have insurance and do not qualify for free Medi-Cal.

Medi - Cal Coverage For Children or Pregnant Females
By applying for coverage for children on this web site, an enroller for California Healthy Families or Medi-Cal for Children / Pregnant Females will contact you to complete the process. The online system will determine which program that you qualify for.

Please complete the below form to be contacted by a certified California Healthy Families Enroller. You will be contacted no more than 2 business days after we receive the completed online form.

(If you desire Health Insurance Coverage for the adult family members in your household, please click on the link to the left)

Applicant Information

YOUR First Name (Adult)	YOUR Last Name (Adult)
Email Address Get free email at Hotmail.com	Daytime Telephone ()
Evening Telephone ()	Cell Phone ()
Applicant Date of Birth

Children To Be Covered

Child #1 First Name

Child #1 Middle Name

Child #1 Last Name

Child #1 Date of Birth

Child #3 First Name

Child #3 Middle Name

Child #3 Last Name

Child #3 Date of Birth

Child #2 First Name

Child #2 Middle Name

Child #2 Last Name

Child #2 Date of Birth

Child #4 First Name

Child #4 Middle Name

Child #4 Last Name

Child #4 Date of Birth

Address Information of Person Applying For Child(ren)

Address	Apt. #
City	State Zip

County

Program Information

Which health insurance program are you interested in?

What is your family size? (all adults and children under 19 years of age living in the home are counted as family members in determining family income. The unborn child of a pregnant woman also counts as a family member.)

What is your family’s Gross Monthly Income?
$

Do you or do any adult family members have an interest in obtaining inexpensive health insurance coverage? CaliforniaHealthyFamilies.us will check with top health insurance carriers and assist with obtaining coverage for family members not eligible for Healthy Families or Medi-Cal Insurance.	Yes No
Do you or do any adult family members have an interest with obtaining inexpensive term life insurance? CaliforniaHealthyFamilies.us will check with top life insurance carriers and assist with obtaining coverage	Yes No

California Insurance License 0827089