Eligibility and Requirements
The Polk HealthCare Plan was created as a last resort for residents with no other option for healthcare coverage. To qualify for membership in the Polk HealthCare Plan you must:
- Be a full-time resident of Polk County
- Have no health insurance coverage or medical coverage
- Have no or low-household income
- Provide a Social Security number
- Provide a valid Florida issued driver license or ID card
- Provide two proofs of residency and proof of income
| Persons in Family/Household | Maximum $ Income/Month | Maximum $ Income/Year |
|---|---|---|
| 1 | $2,430 | $29,160 |
| 2 | $3,287 | $39,440 |
| 3 | $4,143 | $49,720 |
| 4 | $5,000 | $60,000 |
| 5 | $5,857 | $70,280 |
| 6 | $6,713 | $80,560 |
| 7 | $7,570 | $90,840 |
| 8 | $8,427 | $101,120 |
2023 Federal Poverty Level as published in the Federal Register Notice, effective January 19, 2023. For families/households with more than eight persons, add $8,635 annually for each additional person.
What documents do I need to apply?
Accepted examples for proof of income:
- Certification of Zero Income Form
- Court-ordered child support or alimony payments
- Expense records (bank/credit statement, profit and loss statement)
- Pay stubs (four weeks)
- PELL Grant Award Letter
- Pension
- Proof of rental income
- Self-employment Tax Form
- Social Security Award Letter
- Tax Return
- Unemployment Award Letter
- Verification of Earnings Form
- Workers’ Compensation
Accepted examples of Proof of Residency:
- Award Letter / Check from federal or state agency
- Declaration of Domicile / Verification of Support
- Driver License / State Identification Card
- Electric / Water / Gas Bill
- Lexis Nexis Report
- Proof of employment
- Proof of homestead ownership / purchase
- Rental verification completed by landlord
- Rent receipt / lease agreement
- Shelter/Residential Facility Letter and Declaration of Domicile
- Vehicle Registration
- Verification of homelessness from Polk County Court Services Office
- Voter Registration