Your browser does not support JavaScript!
Healthy San Francisco is a program created by the city of San Francisco that makes health care services accessible and affordable for uninsured residents. Healthy San Francisco offers a new way for San Francisco residents who do not have health insurance, to have basic and ongoing medical care.
Healthy San Francisco Logo
Visitors
Visitors Participants Employers Employees Medical Homes Eligibility Staff About Us
English Spanish Chinese

Required Documents

During your application appointment, you will be required to provide the following documentation:

  1. Personal identification
  2. Proof of residency
  3. Proof of household income and assets

This documentation is in addition to the information provided by your employer because it helps the Application Assistor determine if you are eligible for Healthy San Francisco or for a public health insurance program.  The application process is considered incomplete unless all required documents are submitted.

  1.  Personal Identification

Documents must contain a photograph.  ONLY ONE of the following documents is needed: 

  • State Issued Driver License or ID
  • San Francisco ID card
  • U.S Passport
  • Student Picture ID
  • Certificate of Naturalization N-550/N-570
  • U.S Mariner Card
  • Permanent or Temporary Residency Card
  • Consular ID
  • School Record w/date & Place of Birth/parents
  • Cert. of Indian Blood/US Amer. Ind. tribal doc.
  • Employment Authorization Card or ID

2.  Proof of Residency

Documents must have the applicant's name.  ONLY ONE of the following documents is needed: 

  • State Issued Driver License or ID
  • Current Pay Stub
  • Bank Statement
  • Current Tax Return Statement
  • Utility Bill
  • SFUSD School Registration
  • SSI Awards Letter
  • DMV registration 
  • Pension check / Statement
  • Social Security Award Letter
  • General Assistance Letter
  • affidavit of Support - This is a form that someone you live with can sign to vouch for your residency. They will need to provide one of the above items in their name. (download form)


3.  Proof of Income and Assets

ALL documents that exist for any member of the applicant's household must be provided: 

  • Current Pay Stub 
  • Current Tax Return
  • Signed Statement From Employer (download form)
  • Bank Statement
  • Rental Income Receipts or 1040 tax return
  • Bank Book / Annuity Statement
  • Unemployment Benefits Statement
  • Veteran's Statement
  • Worker Compensation Statement
  • Copy of Award Letter
  • Certification from the issuing institution of any Non-retirement stocks, bonds, or certificates of deposit.
  • Account statements for retirement accounts, such as 401K, 403b accounts (value of retirement holdings are not counted toward household assets)