Polk HealthCare Plan Eligibility

Our Member Services Section assists members in getting the most they can from the Polk HealthCare Plan. Case Managers are ready to determine eligibility for potential members, provide information to members on how to access care and educate members on procedures for using the Plan.

The Member Services Section will ensure that individuals enrolled in Chronic Care Choices remain enrolled in the health plan as long as medically appropriate and as appropriate based on the Plan’s financial and medical technical eligibility guidelines. Where members are eligible for additional services by other community providers, they will be referred and their care coordinated by Plan associates to ensure continuity of care.

Eligibility is based on the following major factors

  • Established Polk County residency with intent to remain
  • Income at or below 100% of the Federal Office of Management and Budget (OMB) Poverty Level or lower
  • Adults between the ages of 19-64 who have no other health care coverage available to them including Medicaid and Medicare
  • Ineligible for other public and/or private health insurance plans
  • Limited assets
  • Valid for employment Social Security Card
  • Picture ID

* By Appointment Only
   To make an appointment at any of our locations, please call 534-5387.

Premiums, Deductibles, and Co-Payments

  • There are no premiums or deductibles for the Polk HealthCare Plan.
  • Polk HealthCare Plan clients are responsible to pay co-payments for certain medical services, such as primary care and specialty care office visits, emergency room visits and prescription medications as determined by the Plan. Co-pay amounts are based on household income.
  • There are no co-payments for inpatient hospitalization, outpatient observation/surgery, and in office procedures for the Polk HealthCare Plan.

Identification Card

All Polk HealthCare Plan clients are issued an identification card and are instructed to present it to the health care provider prior to receiving medical services. The identification card denotes the clients name, case ID number, co-payment responsibility, Plan information and effective dates of enrollment. Current identification cards do not have a photo affixed, therefore, it is recommended to ask for clients to present a photo identification card along with the Plan identification card for validation purposes.

Eligibility Income Guidelines

When calculating household eligibility, $90 per month is disallowed (not considered) for clients who are employed. Listed below are the income eligibility guidelines (based on gross income). If you think you may be eligible contact Social Services at (863) 534-5387.

Family Size Annual Income Monthly Income  
1 $10,830 $903
2 $14,570 $1,214
3 $18,310 $1,526
4 $22,050 $1,838
5 $25,790 $2,149
6 $29,530 $2,461
Each Additional Person Annually $3,740 $312
100% of the Federal Poverty Level

Plan Asset Limits

Household Size Limit
One Person $2,000
Two or more $3,000

Provider Manual

Member HandbookClick here to review our member handbook.

Member Handbook

Member Services StrategyClick here to review our member services strategy.

Contact Information

Email Address: phpeligibility@polk-county.net
To schedule an Appointment or for Information call (863) 534-5387
 

 

Not a Licensed Insurance Plan

This is a tax funded program for eligible residents who meet the criteria. The criteria is subject to change. Services are available as funding permits.