Frequently Asked Questions

• Overview
• What types of health services are covered through the insurance programs?
• What different insurance programs are available?
• Why should I purchase health insurance for my children when I can take them to a hospital Emergency Room if they get sick?
• Who qualifies for Family Health Insurance?
• How can I get Family Health Insurance for my newborn child?
• Do the children have to live in the same home with the person who submits the application for enrollment?
• Must my children and I be US citizens in order to be eligible for insurance?
• Must I be a California resident in order to apply?
• Can someone help me fill out the Family Health Insurance enrollment application?
• What paperwork is required to complete an application?
• As a self-employed person, what paperwork must I provide to determine eligibility?
• How soon will I know if my child qualifies for insurance coverage?
• What medical services are available for my child?
• How much will health insurance coverage cost for my child?
• Can I pay my child's insurance premiums in advance?
• Do I have to pay a co-payment for services?
• Will I be able to change plans if I am dissatisfied with my child's coverage?
• If I have a grievance, can I appeal?
• Is there an opportunity for me to change plans if I want to do so?
• Will I need to re-qualify for Healthy Families Insurance?
• By applying for one of these programs, would it jeopardize my immigration status?
• Success Stories

Overview
The Family Health Insurance initiative provides access to health care for uninsured children in Santa Clara County by enrolling them in available no-cost and low-cost insurance programs that comprehensively covers health, dental and vision care. Using innovative outreach strategies, our program focuses on children in families with incomes at or below 300 percent of the federal poverty level (equal to an annual income of $63,600 for a family of four). By reaching children and their families early, this program is intended to prevent more serious and costly health-related problems from occurring later.

Our Enrollment Specialists are bicultural and bilingual and are trained to be culturally sensitive and proficient. Located throughout Santa Clara County at sites where we can best reach uninsured families, we strive to deliver services to families in their native language, and at a health literacy level that is easily understood. Our strategic outreach strategies ensures that families not accustomed to navigating the health and social service programs in our County can still access these programs at such places as their doctor or medical clinic, schools and community-based organizations.  Our work plan also includes follow-up activities with families to educate and offer additional assistance on healthcare navigation. This includes linking families with much needed preventive and wellness programs that are offered under their newly acquired health program. In addition, referrals are extended to families that require more than just health services, such as Immigration and Food Stamps.

Since 2001, our program have assisted over 30,000 children receive or continue to receive health insurance coverage. The programs that we can directly assist children with are: No Cost Medi-cal, Healthy Families, Access to Infants and Mothers, Healthy Kids and Kaiser Child Health Plan. If the child is ineligible for one of the above programs, we can link the families to local brokers who have been screened to assist low income families. Adults are referred directly to our partners at the Social Services Agencies where they can be assisted with not only health insurance, but the various cash programs, such as Food Stamps.

To Contact Us:

Family Health Insurance
1400 Parkmoor Ave
San Jose, CA 95126
Phone: 408.961.9860
Fax: 408.961.9856
Email: healthyfamilies@healthtrust.org

 

Frequently Asked Questions for Families

Q: What types of health services are covered through the insurance programs?

A: Family Health Insurance provides different program options for health, dental and vision insurance. Each program allows for families to select their Health Plan (HealthNet, Santa Clara Family Health Plan, Kaiser, and Blue Shield), and a Medical and Dental provider or “Home”. Depending upon the program, the insurance covers most of the costs when the enrolled is treated by a doctor, dentist or other medical specialist. Additional services from clinics, laboratories, pharmacies and hospitals are also covered.

Q: What different insurance programs are available?

A: Medical insurance is available through one of five programs: Medi-Cal, Healthy Families, Access for Infants and Mothers, Healthy Kids or Kaiser Child Health Plan. These programs receive funding from different sources (federal, state, county or private funding) but all provide the similar health coverage. A Family Health Insurance enrollment specialist will work with you to determine which overall program is appropriate, based on the child's age, residency status, family size and family income level; and you choose the specific plan options that best meet your needs.

Q: Why should I purchase health insurance for my children when I can take them to a hospital Emergency Room if they get sick?

A: Getting treated in an emergency room is 3-4 times more expensive than a trip to the doctor’s office. When hospitals provide emergency care to uninsured Californians, they absorb millions in uncompensated costs. They must recover that money, meaning everyone’s costs go up. Tens of millions of insured Californians—and employers—pay a hidden tax, in the form of higher insurance premiums, higher deductibles, co-pays, and out-of-pocket expenses.

Q: Who qualifies for Family Health Insurance?

A: This program serves the children of parents in our community who earn minimal incomes, are unemployed, don't have medical insurance for a number of reasons (including immigration status), and the Undocumented. Parents, legal guardians, step-parents, foster parents or caretaker relatives may apply for insurance for a child, but only the parents' income will be considered to determine eligibility.

Children, age 18, and under may apply for their own insurance if they meet the income requirements. Minors who do not live with parents, legal guardians, step-parents, foster parents or caretakers may be eligible for the program for themselves or their children if they meet all other requirements.

Newborns and children under one year old may qualify if their family meets the income requirements.

To be eligible for Family Health Insurance, children must be:

• Under the age of 19
• Presently uninsured
• Residents of Santa Clara County
• From a family with income of 300 percent or less of the federal poverty level (equal to an annual income of $63,600 for a family of four)

Q: How can I get Family Health Insurance for my newborn child?

A: You may apply for insurance coverage three months prior to the delivery due date if you provide proof of pregnancy. Once your child is born, proof of birth will be required for us to assist you with finding health insurance coverage.

Q: Do the children have to live in the same home with the person who submits the application for enrollment?

A:No, but in order to be covered, children may have to reside the majority of the year within either the State of California or Santa Clara County, depending on the program in which they are enrolled.

Q: Must my children and I be US citizens in order to be eligible for insurance?

A: No. A parent's immigration status is not considered when determining eligibility. While some plans require an enrolled child to be a citizen, national or qualified immigrant, other plans provide coverage regardless of the child's immigration status.

Q: Must I be a California resident in order to apply?

A: No. As a parent applying for coverage for a child, you do not need to live in California. Depending on the program, however, the child being enrolled must live the majority of the year within either California or Santa Clara County.

Q: Can someone help me fill out the Family Health Insurance enrollment application?

A: Yes. Our Enrollment Specialists are available to assist you. Call 408-961-9893 or submit an e-mail request for assistance to healthyfamilies@healthtrust.org.

Q: What paperwork is required to complete an application?

A: A certain amount of documentation is required to prove income and residency requirements. This documentation typically includes things like recent pay stubs, tax returns, employer letters, school enrollment forms or canceled mail. Our staff will work with you to determine your child's eligibility and enrollment requirements. Approximately 95 percent of the insurance applications we submit are approved for coverage.

Q: As a self-employed person, what paperwork must I provide to determine eligibility?

A: If you are a business owner, your net profit (as stated on your 1040 Federal Tax Return, Schedule C, or quarterly profit/loss statement) will determine your income for Family Health Insurance coverage.

Q: How soon will I know if my child qualifies for insurance coverage?

A: Our staff can provide an initial assessment by phone and if we determine that based upon the conversation, your child will qualify for one of the programs we support, we can then schedule you for a formal interview that will take approximately 30-40 minutes, at a location convenient to you.

Q: What medical services are available for my child?

A: Complete medical coverage, including

• preventive check-up
• Specialist care
• Inpatient and outpatient hospital services
• Mental health care
• Treatment for alcohol and drug abuse
• Vision care
• Dental care
• Prescription coverage
• Use of a 24-hour nurse advice line
• Health education and other services

Q: How much will health insurance coverage cost for my child?

A: Your monthly payment will be based on your income, the number of children covered, and the type of plan. With the Healthy Families and Healthy Kids programs, for example, the monthly payments range from $4-$9 per child with a family maximum of $18-$27.

Q: Can I pay my child's insurance premiums in advance?

A: Yes. If you pay three months of premiums together in advance, you get a fourth month of free coverage. (This option is not available if you pay by Electronic Fund Transfer.)

Q: Do I have to pay a co-payment for services?

A: There may be a co-payment for certain services, but no co-payment is required for preventive services. The co-payment amount is typically $5.

Q: Will I be able to change plans if I am dissatisfied with my child's coverage?

A: All programs offer plan options so you can change plans within the first 30 days of enrollment or during the annual Open Enrollment period.

Q: If I have a grievance, can I appeal?

A: Yes. All programs and plans have a dispute resolution policy. You may also appeal eligibility and enrollment decisions. Enrollment specialists are available to advise you and assist with the filing of a grievance.

Q: Is there an opportunity for me to change plans if I want to do so?

A: Yes. You can make changes during the Open Enrollment period approximately from April 15 through June 30 of each year. At this time, you can choose a new plan or make changes to medical, dental and vision plans. This is also the time to enroll new children. All changes go into effect by July 1 of the same year.

Q: Will I need to re-qualify for Healthy Families Insurance?

A: Yes. Each year you will be asked to confirm the eligibility of your child/children. Enrollment specialists with the Healthy Families Insurance Program will contact you 90 days prior to the expiration of your policy to help gather any documentation that may be required for continued coverage.

Q: By applying for one of these programs, would it jeopardize my immigration status?

A: No. Federal law says that someone who relies mostly on the government for financial support is a public charge. If the U.S. government decides a non-citizen is likely to become a public charge, that person can be barred from entering the U.S. or from becoming a lawful permanent resident. That means the person cannot get a green card. Legal permanent residents cannot be turned down for U.S. citizenship for lawfully getting any benefits.

According to the Federal Public Charge guidelines, an individual seeking health services will not be considered a “Public Charge.” All Kids health insurance should not affect your child's immigration status as long as your child does not receive long term care in a nursing home or mental health facility.

Success Stories
A Latin-American mother of four says she is grateful to be enrolled in the Family Health Insurance Program. Recently her youngest was treated for a head laceration at Franklin-McKinley clinic. "The staff at the clinic were fast, courteous and professional," she reports. "Thanks to them my baby is doing well. And it didn't cost us hundreds of dollars, like the last time when I had to go to the emergency room."

Another Latin-American mother with three children was distraught when her son picked up head lice his school. Initially she tried over-the-counter lotions but her son continued to suffer from constant itching. When the school sent him home, she took him to Franklin-McKinley clinic.

"At first I was so ashamed, she recalls. "I thought we were pretty clean, but the doctor explained to me that the head lice didn't necessarily mean we were dirty and that there was nothing to be ashamed of. She said head lice infect everybody from rich to poor. I don't feel so bad now."

This mother has been following the doctor's orders and using the medication prescribed. Her child should be able to return to school shortly. "Without the health plan, I probably would have not gotten the prescription for the medicine and my child would have had to miss more school," she adds.

An Asian Indian mother of three is a medical assistant at a small OB-GYN clinic. Even though this woman and her husband both work, the high cost of living in this county means that they can now no longer afford health care coverage. "Health insurance is important to me," she declares. "As a health worker, I see the value."

Soon after a cousin told her about The Health Trust, she began working with a Family Health Insurance enrollment specialist who provided guidance during the application process. This woman's children are now covered through the county program and they can continue to see their regular pediatrician at Kaiser.