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Healthy Children Program (Medicaid)

Form Details

Owner: Health and Social Services, Social Services

Link: http://dhss.delaware.gov/dss/files/chip_appl_engl.pdf

Referring Page - Delaware Healthy Children Program

Description: Complete and sign this application form to apply for the Delaware Healthy Children Program, which offers affordable health insurance to uninsured children. You will pay a low monthly premium based on family income. You can also use this form to apply for Medicaid's Diamond State Health Plan for individuals and families.

Form Options

Standard PDF - This type of document can be Viewed and Printed online however, normally it can not be edited or filled-in. To open this type of document you will need to have an application installed on your computer that can read portable document files (PDF). Adobe Acrobat Reader is a free viewer that will allow you to open this type of file. Get Adobe Acrobat

Last Updated: Thursday, 28-Feb-2013
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