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 income or resources too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents with limited income who are residents of New York State and are United States citizens or fall under one of many immigration categories. Your Children are always eligible for one of the Child Health Programs

Family Health Plus provides comprehensive coverage, including prevention, primary care, hospitalization, prescriptions and other services. There are minimal co-payments for some Family Health Plus services. Health care is provided through managed care plans. The available plans are Fidelis, GHI HMO Select, Inc., Hudson Health Plan, MVP or WellCare.

How much does it cost?

There is no cost to apply for Family Health Plus and there are no deductibles once you are enrolled. Once enrolled you may be asked to pay part of the costs of some medical care/services. This is called a co-payment or co-pay. If your family's income or resources exceed qualifying levels, you are not eligible to enroll.

How is healthcare provided?

Health care in the Family Health Plus program is provided through managed care plans. You must select a participating health plan when you apply for Family Health Plus. Every effort will be made to help you pick a plan that includes your current physician. When you choose a health plan, you will have a regular doctor, get regular check-ups and see specialists if needed. Some plans also offer dental care.

What will happen when I apply?

You will need to make an appointment to meet for an hour or so with an enrollment facilitator at your closest Dutchess County Community Action Partnership office. Your Dutchesscap enroller will help you fill out an application for public health insurance, choose a health plan and answer all of your questions. You and your family members can apply for several public health insurance programs (Family Health Plus Child Health Plus and Medicaid) using a single application.

You will be asked for information about the persons living in your household, your household's income, resources, housing expenses, illnesses/injuries, other health insurance as well as your New York State residency, United States citizen or immigration status, and social security numbers of the persons applying for Family Health Plus. You will need to provide proof of the identity, date of birth, residence, current income, dependent care costs, health insurance, citizenship and immigration status for the members of your family applying for insurance. Some adults may need to provide proof of their resources. Your DCCAP enroller will help you identify and gather this documentation. All information is kept confidential and will only be used to verify if you are eligible for public health insurance.

Once your application is complete DCCAP will let you know if you and/or your family appear to be eligible for Family Health Plus or another public health insurance program. (An application is "complete" when it is filled out, all of the required documentation is submitted, a health plan is chosen and it is signed.) We will forward the completed application to your local social services district where it will be reviewed and final insurance eligibility determinations will be made. The local social services district will let you know which health insurance program you qualify for and verify which health plan you chose.

You will get a letter to confirm your eligibility and the plan you chose from your local services district. Your health plan will send you a welcome letter that includes the date you can start using the plan's services and a member ID card. If you need care before your plan-issued ID card arrives, use the plan's welcome letter to show your provider (such as your doctor, clinic, hospital) that you are a member. You will also get a handbook from your health plan that will tell you what services are covered and how you can get health care.

It could take two months or more from the time you sign the application to when you can start getting services from the managed care health plan you chose.

There is no retroactive coverage in the Family Health Plus Program; your coverage begins once you are enrolled in the health plan you chose. If you are determined eligible for FHP, your enrollment should be effective no later than 90 days from the date of submission of your completed application. In the event of an error or delay in your enrollment, Medicaid may be able to pay for reasonable medical expenses covered under FHP. Medicaid may also pay for any unpaid medical expenses, if the provider is an enrolled Medicaid provider.

Questions or comments: 845-437-0222or health@dutchesscap.org