Family Health Plus

Family Health Plus is a public health insurance program for adults between the ages of 19 and 64 who do not have health insurance - either on their own or through their employers - but have incomes too high to qualify for Medicaid.

 

 

 

Eligibility Requirements Include:

• Age: Adults must be between the ages of 19 to 64 years old
• Identity/Date of Birth:  See Document Check List
• Residency: Must be a New York State resident
• Citizenship/Immigration Status: Can be a U.S. citizen or fall under one of many immigration categories. Undocumented immigrants and people on short-term visas who are not in the process of applying for permanent status are not eligible.
• Health Coverage: Adults can not have other health insurance coverage (there are some limited exceptions)
• Assets: The resource (asset) test has been eliminated for all Family Health Plus applicants/recipients.
  Income: Please see chart below for monthly income levels.

Family Health Plus Gross Income Levels This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.
Family Size	Yearly Income	Monthly Income	Weekly Income
Single Adult and 19-20 Year Olds Living Alone	$10,836	$903	$208
Couples with No Children	$14,580	$1,215	$280
1*	$16,248	$1,354	$312
2*	$21,864	$1,822	$420
3*	$27,468	$2,289	$528
4*	$33,084	$2,757	$636
5*	$38,688	$3,224	$744
For each additional person add:	$5,616	$468	$108
* Parent living with at least one child under 21; 19-20 year olds living with their parents
NOTE: Chart effective January 1, 2010. Subject to annual income updates.

Benefits Covered by Family Health Plus

Some of the benefits include:

• Regular checkups;
• Hospital inpatient and outpatient services;
• Emergency room care;
• Prescription drugs;
• Specialist care;
• Smoking cessation agents;
• Medical supplies and equipment.

Family Health Plus Co-payments

Effective September 1, 2005, certain Family Health Plus services will require co-payments.  All co payments should be paid directly to the medical provider.  Providers can not refuse you service if you are unable to pay the co-payment.  However, if you are unable to pay at the time of service, you may be billed for the co-payment amount owed.

Delivery of Service
Health care is delivered through a managed care plan. A managed care plan must be selected at the time of enrollment.

Where to Enroll in Family Health Plus
Individuals can call 311 and ask for the HRA Medicaid helpline to find out if they are eligible for Family Health Plus. Enrollment counselors are available to enroll adults into Medicaid at convenient neighborhood locations. Counselors are located at Medical Assistance Program Offices, community-based organizations, hospitals and health plans to assist individuals in filling out an application. It is important to see an enrollment counselor to assist you with the application process because factors other than those noted above are considered to determine eligibility.
Find out where you can enroll in your neighborhood.

Documentation Check List
Bring a copy of the following documents (in PDF): your last four pay stubs, proof of age, address, identity, and immigration status (for adults only) to your appointment with a health insurance enrollment counselor.

Other Helpful Resources
For more information regarding this and other public health insurance programs, please contact an agency listed below:
Human Resources Administration at 1-877-472-8411
New York State Department of Health at 1-800-541-2831or visit its website at New York State Department of Health

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