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Materials

Materials

There are two ways to get materials from Cover Virginia.

1. Print from web: Need one copy? You can print materials right from this website. Select the language link next to the picture of the document you want below. This opens the document in PDF. If you don’t have Adobe Acrobat Reader, you can download it at Acrobat.

2. Order online: Need multiple copies? You can order many materials in bulk online. Your order will be shipped to you free of charge within two weeks. Fill out and send the form at Order materials.

Applications

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Application for Health Coverage & Help Paying Costs
Print in:[PDF] English | [PDF] Spanish | Order online

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Additional Person Single Page Supplement can be used with an application to apply for more people in your household. The Additional Person Single Page Supplement is not a stand-alone application. You must also complete the Application for Health Coverage & Help Paying Costs and submit the Additional Person Single Page Supplement with the application.

[PDF] English | [PDF] Spanish | Order online

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ABD-LTC Application – Appendix D is for adults over age 19 with a disability and other adults aged 65 or over, including those who need long term care.
[PDF] English | [PDF] Spanish | Order online

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Medically Needy – Spenddown - Appendix E is for children and pregnant individuals who have income greater than the Medicaid limit and would like to be evaluated for a spenddown based on income, resources and medical expenses.
[PDF] English | [PDF] Spanish | Order online

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Nursing or Community Based Care – Appendix F is for those who need help with everyday things to live safely in their home or who have a physical disability or long-term disease, mental or emotional illness, or addiction problem.
[PDF] English | [PDF] Spanish | Order online

Spanish will be available for online ordering starting November 9.

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The FAMIS Select Application is the form FAMIS-enrolled families use to apply for the premium assistance program.[PDF] English | [PDF] Spanish

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The Appeal Request is the form to appeal a denial, cancellation or reduction of coverage.
[PDF] English | [PDF] Spanish

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The Co-Payment Tracking Form helps families keep track of their FAMIS co-payments.
[PDF] English | [PDF] Spanish

Coverage for Adults

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The New Adult Health Coverage Brochure is a helpful resource with information on new health coverage for Virginia adults.
[PDF] English | [PDF] Spanish | Order online

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The New Adult Health Coverage Flyer is a helpful resource with information on new health coverage for Virginia adults. The flyer is available in English, Spanish, and as a double-sided flyer with English on one side and Spanish on the other side.
[PDF] English | [PDF] Spanish | [PDF] Double-sided | Order online

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The New Adult Health Coverage Poster is a helpful resource that community partners can display. It has information on new health coverage for Virginia adults. The 11" x 17" poster is available for print in English, Spanish, and as a double-sided poster, with English on one side and Spanish on the other side.
[PDF]  Double-sided | Order online

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The New Health Care for Adults Income Guideline Chart has the 2021 income guidelines for Virginia’s health insurance programs for adults ages 19 to 64.
[PDF] English | [PDF] Spanish

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The Adult Coverage Multi-Language Flyer has information on the new health coverage for adults, including who is eligible, how to apply and what services are covered.

The flyer is available in 18 languages.


[PDF] EnglishSpanishAmharicArabicBengaliChineseFarsiFrenchHindiKoreanKurdishNepaliRussianSomaliSwahiliTagalogUrduVietnamese

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The Medicaid Member Handbook is sent to all Medicaid members. It has information on member benefits, renewal requirements, who to call about lost ID cards and more.
This handbook is only available for order by department of social services (DSS) offices.

[PDF] English | [PDF] Spanish

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The Hospital Presumptive Eligibility (HPE) Income Guideline Chart has the 2021 income guidelines for temporary coverage for children, pregnant individuals, and Low- Income Families with Children (LIFC).
[PDF] English

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The Plan First Brochure has information about Virginia’s free family-planning program for men and women.[PDF] English | [PDF] Spanish | Order online

FAMIS and FAMIS MOMS (children and pregnant women)

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The FAMIS Brochure is a helpful resource with information on Virginia’s health insurance program for uninsured children.
[PDF] English | [PDF] Spanish | Order online

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The FAMIS Flyer is a helpful resource with information on Virginia’s health insurance program for uninsured children. The flyer is available in English, Spanish, and as a double-sided flyer with English on one side and Spanish on the other side.
[PDF] English | [PDF] Spanish | [PDF] Double-sided | Order online

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The FAMIS Poster is a helpful resource that community partners can display. It has information on Virginia’s health insurance program for uninsured children. The 11" x 17" poster is available for print in English, Spanish and as a double-sided poster with English on one side and Spanish on the other side.
[PDF] Double-sidedOrder online

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The FAMIS Multi-Language Flyer has information about the FAMIS and FAMIS Plus programs, including who is eligible, how to apply, and what services are covered. The flyer is available in 15 languages.

[PDF] EnglishSpanishTraditional ChineseSimplified ChineseVietnameseArabicFarsiKoreanRussianHindiAmharicFrenchKurdishUrduSomali

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The FAMIS Immigrant Flyer has information about the FAMIS and FAMIS Plus programs for immigrants. The flyer is available in 10 languages.


[PDF] EnglishSpanishTraditional ChineseSimplified ChineseVietnameseArabicFarsiKoreanRussianHindi

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The Income Guidelines Chart has the 2021 income guidelines for Virginia’s health insurance programs for families and children.
[PDF] English | [PDF] Spanish

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The Smiles For Children Brochure has information about regular dental checkups and instructions on how to find dental providers.
[PDF] English

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The FAMIS MOMS Flyer has information on Virginia’s health insurance program for uninsured pregnant individuals. The flyer is available in English, Spanish and as a double-sided flyer with English on one side and Spanish on the other side.
[PDF] English | [PDF] Spanish | [PDF] Double-sided | Order online

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The FAMIS Member Handbook is sent to all FAMIS members. It has information on member benefits, renewal requirements, who to call about lost ID cards and more.
This handbook is only available for order by department of social services (DSS) offices.

[PDF] English | [PDF] Spanish

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The FAMIS MOMS Member Handbook is sent to all FAMIS MOMS members. It contains information on covered services, other services, prenatal care and more.
This handbook is only available for order by department of social services (DSS) offices.
[PDF] English | [PDF] Spanish

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FAMIS Select Brochure provides information about the FAMIS Select program. FAMIS Select helps families with children enrolled in FAMIS pay for private or employer-sponsored health insurance.
[PDF] English | [PDF] Spanish

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