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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.
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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 helps the Application Assistor determine if you are eligible for Healthy San Francisco or for another public health insurance program.  Your application will be considered incomplete untill all required documents are submitted.

  1.  Personal Identification

ONLY ONE of the following documents is needed:

Your personal identification must contain a photograph.

  • 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
  • Certificate of Indian Blood/US American Indian tribal document
  • Employment Authorization Card or ID

2.  Proof of Residency

  Personal Identification

ONLY ONE of the following documents is needed:

Your proof of residency must show your name.  

  • State Issued Driver License or ID
  • Current Pay Stub
  • Bank 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. (Click here to download the form)

    • Individuals living temporarily in San Francisco on an active visa (student visa or tourist visa) may not be eligible for Healthy San Francisco.


3.  Proof of Income and Assets

You must provide the most recent documentation for all members of your household.

  • Current Pay Stub 
  • Current 1040 Tax Return
  • Signed Statement From Employer, (Click here to download the form)
  • Bank Statement (cannot be a printout of your transaction, it must be an actual 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).

If you are self-employed or own a small business and do not have a current tax return, you may use a Profit and Loss Statement to document your income.