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
