MR #15.18: HFS 2378ABE-Application for Health Coverage & Help Paying Costs

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

07/27/2015

A new medical application, HFS 2378ABE/S (N-3-15), Application for Health Coverage & Help Paying Cost, is available when applying for health coverage:

  • for children;
  • parents or other caretaker relatives raising dependent children;
  • pregnant women; and
  • other adults age 19 through 64.

HFS 2378ABE/S is available online at http://www2.illinois.gov/hfs/MedicalProvider/MedicalProgramForms/Pages/medicalnumeric.aspx or call 1-800-843-6154 (TTY: 1-866-324-5553).  Applicants are instructed to carry, mail or fax their completed application to their local Department of Human Service (DHS) Family Community Resource Center (FCRC). 

Hard copy applications can be requested by contacting:

  • Illinois Department of HealthCare and Family Services
  • Publications Request
  • 201 South Grand Avenue East, 3rd Floor
  • Springfield, IL 62763

Applicants are advised they can apply for medical benefits faster online at https://abe.illinois.gov/abe/access/.

This manual release does not obsolete existing applications.

[signed copy on file]

James T. Dimas

Secretary-Designate, Illinois Department of Human Services

Felicia F. Norwood

Director, Illinois Department of Healthcare and Family Services

Manual Revisions

WAG 02-04-00

Forms Referenced

HFS 2378ABE

HFS 2378ABES