Download an Application
- Download the application and instructions in English [1.1 MB PDF]
After you have printed the form, fill it out, sign it, attach the necessary documentation (Family Check List) and mail it in. Be sure to fill out the whole form, front and back, and attach the necessary income documentation.
Monthly premiums are based on your household size and monthly income. Most families pay $15 or $20 per family per month. If you need to pay more, we will let you know.
If you send a check or money order for the first month's premium, the check should be made out to: Florida KidCare.
If you have previously applied for Healthy Kids and KidCare please contact our toll-free customer service department at 1-800-821-5437 to reactivate your application. You may not need to submit a new application.
To submit an application you can:
Mail it to:
Healthy Kids and KidCare
Post Office Box 980
Tallahassee, Florida 32302-0980
Fax it to: (866) 867-0054 (TOLL FREE)
Email it to: firstname.lastname@example.org
The application form has space for three children. If there are more than three children, attach the information on another sheet of paper.
- Your family's most recent tax return (Form 1040) OR
- Your Wage and Earning Statement (W-2 Form) OR
- Current Pay Stubs (covering the last 4 weeks)
- Your children's Social Security numbers or the date applied for if you have not received a Social Security card.
- Proof of Citizenship and Identity
You may complete the My Application Check List to see what forms you need to have handy.