Income Eligibility for Healthy Families in California

Your clients may qualify for the Healthy Families Program if their family’s monthly pretax income falls into one of the following ranges^*:

^*Each child in a family is reviewed individually within their age bracket and correlating income guideline.
^**Family size of one takes into account a child that may receive monthly recurring income such as pensions, social security or trusts from the estate of deceased parents. Income from legal guardians is not included in income reviews.

Plans & Rates: Healthy Families

The Healthy Families Program provides medical, dental and vision coverage to children under the age of 19 who do not currently have medical coverage and do not qualify for no-cost Medi-Cal.

We offer two plans, and a member’s plan is based on the county where he or she lives. In general, the benefits and services are the same in both plans. Visit Service Areas to find out which plan your client is eligible for.

Plan Types

Our HMO plan is a traditional managed care plan where a Personal Physician selected by the member provides or coordinates all care. There are more than 14,000 Personal Physicians and 220 hospitals for members to choose from.

Our EPO Plan offers the same benefits as our HMO Plan with a different network of physicians. There are more than 4,000 Preferred physicians and 50 hospitals from which EPO members can access healthcare services.

Cost and Copayments for Healthy Families in California

Your client’s family will pay between $7 and $15 per month for each child depending on the family’s monthly income. There is a $45 per month maximum cost for all children in an enrolled family.

Clients can save money by paying on a quarterly basis rather than monthly. When a client pays three months in advance, the fourth month of coverage is free.

Members pay only a $5 copayment for each office visit and each prescription, and will not pay more than $250 in annual health benefit copayments for all children enrolled in the family. A list of covered benefits is included in the plan summaries.

Service Areas

Our Healthy Families Program service areas are based on counties, as indicated below:

HMO Service Areas

Alameda, El Dorado^*, Los Angeles, Marin, Nevada^*, Orange, Placer^*, Riverside^*, Sacramento, San Bernardino^*, San Francisco, San Joaquin, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Tulare, Ventura and Yolo counties.

EPO Service Areas

Butte, Calaveras, Del Norte, Glenn, Humboldt, Imperial, Kings, Lake, Madera, Mendocino, Merced, San Benito, San Diego, San Luis Obispo, Shasta, Stanislaus, Tehama, Tuolumne and Yuba counties.