This is an official California Judicial Council family law form, which may be used in domestic litigation in California. Enter the information as indicated on the form and file with the court as appropriate.
Long Beach California Application and Order for Health Insurance Coverage
State:
California
City:
Long Beach
Control #:
CA-FL-470
Format:
PDF
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Description
How to fill out Long Beach California Application And Order For Health Insurance Coverage?
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FAQ
An unmarried resident may be eligible for Medi-Cal benefits if he/she has less than $130,000 in countable resources. The Medi-Cal recipient is allowed to keep from his/her monthly income a personal allowance of $35 plus the amount of any health insurance premiums paid.
Income-based Medi-Cal Your family size:1 2 3 4 5 6 7 8 9 10 11 12$12,880$4,540Income-based Medi-Cal, adults (138% FPG)$18,754Income-based Medi-Cal, children (266% FPG)$36,1496 more rows
2022 Income Eligibility Guidelines for PE4PW Household Size213 Percent Monthly213 Percent Annually2$3,251$39,0013$4,090$49,0544$4,927$59,1085$5,764$69,1628 more rows ?
Income-based Medi-Cal Your family size:1 2 3 4 5 6 7 8 9 10 11 12$12,880$4,540Income-based Medi-Cal, adults (138% FPG)$18,754Income-based Medi-Cal, children (266% FPG)$36,1496 more rows
The Modified Adjusted Gross Income (MAGI) Medi-Cal method uses Federal tax rules to decide if you qualify based on how you file your taxes and your countable income.
Medi-Cal does have the option to review an applicant's income on an annual basis. For a single adult, the monthly Medi-Cal income was $1,482. In 2022, the monthly income will increase to $1,564. In other words, an adult can earn up to $1,564 per month and still qualify for no cost Medi-Cal.
Medi-Cal Programs ? Qualification at a Glance ? 2022 Note: Higher income levels apply for individuals who are blind. Single: up to $1,584/mo. Couple: up to $2,126/mo. Single: over $1,584/mo.
Only persons who are applying for Medi- Cal must give their SSN and information about their immigration or citizenship status. People who are not applying for Medi-Cal are not required to give an SSN or proof of immigration or citizenship status.
What will happen after I apply for health coverage? You will receive a letter within 45 days to tell you which program you and your family members qualify for. If you don't hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).
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Molina Healthcare has provided the best healthcare quality and affordability for more than 40 years. See what sets us apart.Where can I get help filling out the form and if I have questions? Meet with an Advisor. Find a Medicare plan that fits your healthcare needs and your budget. (in-network), or Cigna Health and Life Insurance Company (out-of-network). Please keep it in a safe place. Find the health insurance plan to fit your needs from Humana. Florida Health Care Plans provides people with medical plans all across the state. Let us know what you need from your health plan.