Community: Assistor Tools: Healthy Kids
Healthy Kids
Reference Materials
- MEMO: Important Rate Changes for Healthy Kids & Healthy Families Program, October 2009
- Healthy Kids Main Website
- HK Application Assistor Reference Manual
- Federal Poverty Level (FPL) Guidelines for Health Programs
- HK Income Guidelines & Premium Categories (Effective April 1, 2012)
Enrollment Forms
- Application (English, Chinese, Spanish)
- Add a Member
- Annual Renewal Application
- Premium Assistance (English, Chinese, Spanish)
- Incomplete Application (English, Chinese, Spanish)
Verification Forms/Documents
- Child Day Care Form (English, Chinese, Spanish)
- Child Support Received Form (English, Chinese, Spanish)
- Gift Letter Form (English, Chinese, Spanish)
- Income Documentation for Renting a Room Form (English, Chinese, Spanish)
- Rental Income Worksheet (English, Chinese, Spanish)
- Sample Employer Letter (English, Chinese, Spanish)
- Sample Profit & Loss Statement (English, Chinese, Spanish)
- Sample Self Affidavit of Income Letter (English, Chinese, Spanish)
Documents and forms posted on this webpage have been created by the San Francisco Health Plan. We have posted them so applications assistors can conveniently access them.
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