Florida Kidcare PDF Details

If you are a Florida resident with children, you may be eligible for Florida Kidcare. This affordable health insurance program provides coverage for preventive care, doctor visits, prescription medications, and more. In this post, we will discuss the eligibility requirements for Florida Kidcare and how to apply. We will also provide some helpful tips on how to use your benefits. So whether you are just starting out on your parenting journey or you are looking for a new health insurance option for your growing family, read on to learn more about Florida Kidcare.

You will see information about the type of form you want to submit in the table. It can tell you the length of time you will need to finish florida kidcare, exactly what fields you will need to fill in, etc.

Form NameFlorida Kidcare
Form Length1 pages
Fillable fields28
Avg. time to fill out5 min 55 sec
Other nameskidcare florida application medication, florida kidcare income verification form, florida kidcare form, self employment kidcare florida form

Form Preview Example



General Directions: Copy this form and have it completed by each employer that provides income to a family member on the KidCare application. If you provide recent pay stubs, you do not need this form completed.

Complete Section A and submit to employer for completion. Completed form must be returned to Florida KidCare, P O Box 591, Tallahassee, Florida, 32302-0591.

Section A – To Be Completed by Employee

Family Account Number: __________________________

I authorize the release of employment information for the purpose of determining KidCare eligibility.

Employee Signature: _________________________________ Date: ___________________

Employee Name: _____________________________ Employee SSN: __________________

(please print)

Section B – To Be Completed by Employer

Directions: This information is needed to help determine eligibility for KidCare Health Insurance. Please assist us by answering the following questions for the employee listed above, and returning this form to: Florida KidCare, PO Box 591, Tallahassee, Florida, 32302-0591.

(1) Number of Hours Worked Per Week: _______

Number of Days Worked Per Week: _______

(2) How often is the employee paid:

_ Daily

_ Weekly _ Bi-Weekly _ Monthly

_ Twice Monthly

_ Other: _______________



(3) Rate of gross pay: $ ___________ per _________________

_ Other: _______________



(4)If hours or rate of pay has varied in the above period, please state why (include tip information here): ________________________________________________________________________



(5)Employer Statement: What I have written on this form is true to the best of my knowledge. I know that if I give false information on purpose, I may be subject to prosecution for fraud.



Signature of Employer

Employer’s Title


(________) ___________________________

Name of Employer (please print)

Employer’s Telephone Number



Name of Business

Date Completed



Business Address

City, State, Zip



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florida kidcare form fields to fill out

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step 3 to filling out florida kidcare form

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