Healthy Kids HMO

Healthy Kids HMO is a locally funded program for low-income children who do not qualify for Medi-Cal or other health insurance.

Who is eligible

Children and teens from birth to age 19, regardless of immigration status. To ask about your eligibility status, call HPSM Member Services.

What is covered

  • Doctor and hospital visits
  • Prescription drugs
  • Dental care (call Delta Dental: 1-866-527-9564)
  • Eye care
  • Preventive care – such as health exams, screenings, tests, immunizations and other office visits with a primary care doctor

Cost

Quarterly Contribution

Families pay a quarterly amount (every three months) for each child in Healthy Kids. The cost depends on a family's income category and is either $0, $63 or $150 per quarter.

To learn which income category your family is in, call HPSM Member Services.

Please mail payments to:

Health Plan of San Mateo
Attn: HPSM Finance Department
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080

Co-pays

Members pay co-pays for some services. Depending on your income category, your co-pay will be $5, $10, $15 or more. There is no co-pay for children under two years of age and preventive care visits for all children. There is an annual co-pay cap.

  • The most that one household could pay in one benefit year is $250 or $1,000 (depending on income).
  • All co-pays paid for Healthy Kids members in your household apply toward your annual cap.
  • Keep all receipts from doctor visits and prescriptions for your family’s Healthy Kids members.
  • HPSM will send you a letter letting you know when you no longer have to pay co-pays.
  • Bring that letter to all doctor and pharmacy visits for the rest of the year. Then you won’t have to pay any more co-pays.

Apply

To apply for Healthy Kids HMO, call the Health Coverage Unit at 650-616-2002. Parents and legal guardians may apply on behalf of children.