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Medical Assistance Eligibility


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Application for Healthy Kids Medical Insurance

Aplicación para el Healthy Kids Cobertura Médica

Form 800P

Owner:

Division of Family Assistance,

NH Healthy Kids Corporation

Effective Date:07/01/2002

If your child is uninsured because of the high cost of health insurance, or because you do not have access through your employer, NH Healthy Kids may be able to help.  Children can qualify for Healthy Kids if they are under the age of 19, have no other health insurance coverage and household income is no higher than 300% of the federal poverty income limits.   

 

To ensure your child is covered as quickly as possible, the application must be completed in full and proof of the following items must accompany the application: family income; expenses you want to claim; child's age; New Hampshire residency; citizenship or immigration status; and health insurance (if child has current insurance or has been insured in the past six months).  A premium payment may be required in certain circumstances, but you will be contacted regarding the amount of any premium.  If applicable, premiums are $25 or $45 per child per month up to a maximum of $100 monthly per family.  See page 4 of the Healthy Kids Application (8 pages) for more details regarding documentation acceptable as proof for the above items.

 

Esta es su aplicación (8 páginas) para el Seguro Médico de Healthy Kids de New Hampshire o Cobertura Médica para Mujeres Embarazadas.  El Seguro Médico Healthy Kids de New Hampshire puede proveer cobertura de seguro dental y de salud para niños menores de 19 años. Algunas familias podrían tener un co-pago o una prima mensual. 

 

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