Application
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This one application can be used to apply for Child Health Plus, Family Health Plus, Medicaid and the Family Planning Benefit Program. Based upon the information you provide, you will be told which program you and/or your children are eligible for. You can use ACCESS NY Public Health Insurance Eligibility Screening Tool to see which public health insurance programs you and your family may be eligible for.
Please Note: This application will help you determine the kind of information that is needed to see if you are eligible for public health insurance. Although you do not have to have a personal interview to apply for public health insurance, you may request application assistance. If you need help filling out the application or need help determining what documents you need to submit, you can call 877-934-7587 or call or visit your local department of social services.
There are a few ways you can fill out the ACCESS NY Health Care application. You can print out the ACCESS NY Health Care application by clicking on the links below and fill it out by hand.
You also can use the "Fill and Print" ACCESS NY Health Care application. With the "Fill and Print" ACCESS NY Health Care application, you can fill out the application on your screen and print the completed form. Please note that if you choose to use the "Fill and Print' ACCESS NY Health Care application, you will not be able to save the information you typed into the application to your computer. Click here for the "Fill and Print" ACCESS NY Health Care application.
You can then mail or drop off your application and the required documents to your local department of social services or the NYC Human Resources Administration. If you are only applying for Child Health Plus, you can mail in or drop off your application and required documents to a Child Health Plus Health Plan.
Click here for more information: What will happen when I apply?
The Access NY Health Care application is available as an Adobe Acrobat Portable Document Format file. Do you need help working with PDF Files?
Forms
English
- Instructions (PDF, 281KB, 4pg.)
- Application (PDF, 415KB, 9pg.)
- Documents Needed When You Apply for Health Insurance (PDF, 259KB, 3pg.)
- Fact Sheet (PDF, 111KB, 1pg.)
- Supplement A (PDF, 147KB, 6pg.)
- All of the FHPlus application files in one (PDF, 610KB, 16pg.)
Spanish
- Instrucciones (PDF, 2.69MB)
- Applicación (PDF, 423KB)
- Documentos Necesarios Para Solicitar Seguro médico (PDF, 690KB)
- Hoja de Hechos (PDF, 49KB)
- Suplemento A (PDF, 147KB, 6pg.)
Do You Have Questions or Need Help Completing This Form?
Call Toll-Free
- For Children: 1-800-698-4543
- For Adults: 1-877-9FHPLUS
- All Help Is Free
- (1-877-898-5849 TTY line for the hearing impaired)
