Get an Application

Am I eligible for the HealthyCare Card?

If you are uninsured and eligible for health insurance, you will need to pursue these options before submitting this application: Health insurance from your employer, or spouse’s employer, Medicare, the Federal Health Insurance Marketplace, Medical Assistance.  Even with commercial health insurance you may still be eligible for financial assistance.  Eligibility is based on household income, assets and insurance eligibility.

If you have questions, please contact us and we will help guide you.

Not sure when your card expires?

The expiration date is located on the bottom right corner of your card.   

 

Download the HealthyCare Card application – English Version - PDF

One Person Application(5 pages) Two Person application (6 pages) Click here for each additional person applying
(2 additional pages)

Download the HealthyCare Card application – Spanish Version - PDF

One Person Application(5 pages) Two Person application (6 pages) Click here for each additional person applying
(2 additional pages)

 

After completing an application please send it to:

In Adams County:
Healthy Community Network
39 N. Fifth Street
Gettysburg PA 17325

In Lancaster, Lebanon & York County:
Healthy Community Network
116 South George Street, Suite 101
York, PA  17401