Child Health Plus

Growing Up Healthy Application

Use following application only when applying for health insurance for children under the age of 19.

To view the Growing Up Healthy application and instructions for completing it, just click on one of the links below. The files they link to are in the Adobe Portable Document Format (PDF - help with PDF). Help is available with completing the application, but if you would like to submit it directly to an insurer, please read these directions first.

• Growing Up Healthy application (PDF, 112KB, 8pg.)
  • Spanish language application (PDF, 728KB, 8pg.)
• Instructions
  • Spanish language instructions (PDF, 1.3MB, 4pg.)

Click here for important instructions on how you can print and mail in an application.

You can also receive a copy of the application by calling 1-800-698-4KIDS (1-800-698-4543). If you are hearing impaired, call the TTY number, 1-877-898-5849.