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Materials

There are two ways to get materials from Cover Virginia.

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Application for Health Coverage & Help Paying Costs.


Print in English | Print in Spanish | Order Online


Additional Person Single Page Supplement can be used with an application to apply for additional people in a person’s household. The Additional Person Single Page Supplement is not a stand-alone application. You must also complete the Application for Health Coverage and Help Paying Costs and submit the Additional Person Single Page Supplement with the application.


Print in English | Print in Spanish | Order Online


ABD-LTC Application – Appendix D is for adults over age 19 with a disability and other adults aged 65 or over, including those who need long term care.


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Appendix E - Medically Needy - Spenddown is for children and pregnant women who have income greater than the Medicaid limit and would like to be evaluated for a spenddown based on income, resources and medical expenses.


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The Income Guidelines Chart features the 2017 income guidelines for Virginia’s health insurance programs for families and children.

This Chart is available in English and Spanish.

Print in English | Print in Spanish


The FAMIS Member Handbook is sent to all FAMIS enrollees. It contains information on member benefits, renewal requirements, who to call about lost ID cards, and more.

This handbook is only available for order by Department of Social Services (DSS) offices.

Print in English | Spanish


The FAMIS MOMS Member Handbook is sent to all FAMIS MOMS enrollees. It contains information on covered services, other services, prenatal care, and more.

This handbook is only available for order by Department of Social Services (DSS) offices.

Print in English | Spanish


Central/Halifax and Tidewater Regions FAMIS MCO Plan Comparison Chart lists Managed Care Organizations (MCOs) that cover children enrolled in FAMIS in the Central, Halifax and Tidewater areas of Virginia. This chart is only available for order by Department of Social Services (DSS) offices.


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Winchester, Northern Virginia and Charlottesville Region FAMIS MCO Plan Comparison Chart lists Managed Care Organizations (MCOs) that cover children enrolled in FAMIS in the Winchester, Northern Virginia and Charlottesville areas of Virginia. This chart is only available for order by Department of Social Services (DSS) offices.


Print in English | Spanish | Order Online


Far Southwest and Roanoke/Allegheny Region FAMIS MCO Plan Comparison Chart lists Managed Care Organizations (MCOs) that cover children enrolled in FAMIS in the CentralFar Southwest and Roanoke Allegheny areas of Virginia. This chart is only available for order by Department of Social Services (DSS) offices..


Print in English | Spanish | Order Online


The 2017 Back To School FAMIS Flyer is the yellow flyer that is distributed to all participating public schools in the state, offering information on Virginia’s health insurance program for uninsured children.

The flyer is available in English, Spanish, and as a double-sided flyer with English on one side and Spanish on the other side.


Print in English | Spanish | Double-Sided | Order Online


The FAMIS brochure is a helpful resource that provides information on Virginia’s health insurance program for uninsured children.

The brochure is tri-fold and is available in English and Spanish.


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The FAMIS Flyer is a helpful resource that provides information on Virginia’s health insurance program for uninsured children. The flyer is available in English, Spanish, and as a double-sided flyer with English on one side and Spanish on the other side.


Print in English | Spanish | Double-Sided | Order Online


The FAMIS Poster is a helpful resource community partners can display that provides information on Virginia’s health insurance program for uninsured children. The 11" x 17" poster is available for print in English or Spanish, and is also available for order double-sided, with English on one side and Spanish on the other side.


Print in English | Spanish | Order Online


The FAMIS MOMS Flyer Flyer offers information on Virginia’s health insurance program for uninsured pregnant women. The flyer is available in English, Spanish, and as a double-sided flyer with English on one side and Spanish on the other side.


Print in English | Spanish | Double-Sided | Order Online


The FAMIS Multi-Language Flyer features information about the FAMIS and FAMIS Plus programs, including who is eligible, how to apply, and what services are covered.

The flyer is available in 15 languages.

Print in English | Spanish | Traditional Chinese | Simplified Chinese | Vietnamese | Arabic | Farsi | Korean | Russian | Hindi | Amharic | French | Kurdish | Urdu | Somali


The FAMIS Immigrant Flyer features information about the FAMIS and FAMIS Plus programs for immigrants

The flyer is available in ten languages.

Print in English | Spanish | Traditional Chinese | Simplified Chinese | Vietnamese | Arabic | Farsi | Korean | Russian | Hindi


FAMIS Select Brochure provides information about the FAMIS Select program. FAMIS Select helps families with children enrolled in FAMIS pay for private or employer-sponsored health insurance.

This Application is available in English and Spanish.

Print in English | Spanish


FAMIS Select Application is the form used by FAMIS enrolled families to apply for the premium assistance program.

This Application is available in English and Spanish.


Print in English | Spanish


The Plan First Brochure provides information about Virginia’s FREE family planning program for men and women.

This Application is available in English and Spanish.

Print in English | Spanish | Order Online


The GAP Poster is a helpful resource community partners can display that provides information on Virginia’s health insurance program for uninsured adults with serious mental illness. The 11" x 17" poster is available for print, and is also available for order double-sided, with English on one side and Spanish on the other side.

Print in Double-Sided | Order Online




The Smiles For Children brochure provides information about regular dental checkups and instructions on how to access dental providers.

This Brochure is available in English.


Print in English


The Smiles For Children Member Handbook is sent to all FAMIS and FAMIS Plus enrollees. It contains information on dental benefits for enrolled children.

This Handbook is available in English and Spanish.


Print in English | Spanish


The Appeal Request is the form a family needs to appeal denial, cancellation, or reduction of coverage.

This form can be used for FAMIS, FAMIS Plus (children's Medicaid), FAMIS MOMS, or Medicaid for Pregnant Women appeals.

The Form is available in English.


Print in English


The Co-Payment Tracking Form should be used to help families keep track of their FAMIS co-payments.

The Form is available in English and Spanish.


Print in English | Spanish