How to sign up to be a sponsor

First, make sure you meet the basic requirements. The following individuals or groups may not be Family Contribution Sponsors:

• A person who is a health, dental or vision care provider who participates in the Healthy Families Program, or an organization composed primarily of or controlled by such persons.
• An entity (including governmental, school, non-profit and charitable organizations) that is or that operates an institution or facility that is a health, dental, or vision care provider that participates in the Healthy Families Program.
• A health, dental or vision plan that participates in the Healthy Families Program.
• Any person or entity acting on behalf of or representing a person or entity described above.

The registration form will ask you to certify that:

• You are eligible to be a Family Contribution Sponsor.
• You acknowledge that Managed Risk Medical Insurance Board (MRMIB) has taken no position as to whether payment of premiums as a Family Contribution Sponsor by any person or entity would be in violation of federal fraud and abuse laws.
• You will allow each sponsored applicant to make his or her own choice among participating plans in his or her county of residence as identified by the Healthy Families Handbook.
• You will sponsor all eligible persons in the household.

To apply to be a sponsor, download a copy of the Sponsor Registration Form or call 1-800-880-5305 to request the form be sent to you (the call is free). Do not ask the operator if you are eligible to be a sponsor. You must read the requirements and decide for yourself. If you are uncertain about your status, consult your own attorney.

Fax the completed Family Contribution Sponsor Registration Form to 1-866-848-4974 or mail it to:

Healthy Families Program
Attn: Sponsorship Registration
P.O. Box 138005
Sacramento, CA 95813-8005

Healthy Families will notify you by mail about your acceptance as a Family Contribution Sponsor. The program will issue an I.D. number to each registered individual or entity and provide you with the Sponsorship Payment Form. You cannot sponsor a family unless you register and are issued an I.D. number.

If you have questions, call 1-800-880-5305, Monday to Friday, 8 a.m. to 8 p.m., or on Saturday, 8 a.m. to 5 p.m. The call is free.

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