About Your Coverage

If your child is enrolled in Healthy Kids Silver or Healthy Kids Buy-In, here are some documents that will be helpful to you.

Documents:

Welcome Letter (PDF 1,477KB)
This letter will give you an overview of your child’s coverage and introduce you to the Healthy Kids programs. It has helpful contact information and payment information as well.

Harvard Pilgrim Health Care

Healthy Kids Silver Member Coverage Certificate (PDF 539KB)

Healthy Kids Silver Cost Sharing Table (PDF 158KB)

Healthy Kids Buy-In Member Coverage Certificate (PDF 539KB)

Healthy Kids Buy-In Cost Sharing Table (PDF 158KB)

Northeast Delta Dental

Summary of Healthy Kids Silver & Buy-In Dental Benefits (PDF 34KB)

Healthy Kids Silver & Buy-In Dental Plan Description (PDF 171KB)

For medical coverage prior to July 1, 2009:

Anthem Blue Cross and Blue Shield

Healthy Kids Silver Member Coverage Certificate (PDF 332KB)

Healthy Kids Silver Cost Sharing Table (PDF 46KB)

Healthy Kids Buy-In Member Coverage Certificate (PDF 236KB)

Healthy Kids Buy-In Cost Sharing Table (PDF 50KB)

Renewal Forms:

Renewal Application (PDF 135KB)
Use this application for the yearly renewal of your child’s health coverage

Renewal Application - Spanish Version (PDF 164KB)
Use this application for the yearly renewal of your child’s health coverage

Accounting Forms:

Healthy Kids Silver Automated Premium Payment (PDF 24KB)
Use this form to authorize NHHK to automatically withdraw your premium payments from your bank account.

Healthy Kids Buy-In Automated Premium Payment (PDF 26KB)
Use this form to authorize NHHK to automatically withdraw your premium payments from your bank account.

Reporting Changes:

Instructions for Reporting Income & Address Changes