Forms & Documents
Member Handbook (DRAFT - effective 1/1/2010)- Member Eligibility Checklist
- Member Plan Benefits Design (DRAFT - effective 1/1/2010)
- Member Contract for Care
- Authorization for Release of Information
- PCP Change Request
- Verification of Earnings
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.
 Polk's Government Television |
 Funding for the Polk HealthCare Plan is made possible by a voter approved ½ cent discretionary sales surtax for indigent health care services. |
For any questions/comments on the site, email joyjohnson@polk-county.net