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Official source

COMBINED MEDICAID 307-1 Cobra 75 Supersedes: FMA 308-1 (01/01/08); MA 305-4 (07/01/05) Reference: 26 CFR 54.4980B-7. ARM 37.82.101, .430 Overview: When cost effective, COBRA 75 Continuation health plan premiums are paid for individuals who are not Medicaid eligible, but who meet COBRA 75 non-financial and financial guidelines. TPL administers health insurance premium payments. COBRA 75 applicants have only a 60 day window of opportunity to establish continued participation in a health care plan they would otherwise lose due to a qualifying event. NONFINANCIAL REQUIREMENTS: The following nonfinancial eligibility criteria must be met: 1. citizenship or alienage; 2. state residency; 3. Social Security number; and 4. Are eligible to receive continued health plan coverage through an employer with at least 75 employees because of a qualifying event. NOTE: Applicants do not have to meet categorical (i.e., aged, blind, disabled, pregnant, etc.) eligibility criteria. FINANCIAL REQUIREMENTS: Countable resources cannot exceed: 1. $4,000 for one individual; or 2. $6,000 for a family with two or more people. Countable monthly income cannot exceed 100% of the federal poverty guidelines based on family size. NOTE: Appropriate ABD (Aged, Blind, Disabled) Medicaid income disregards and exemptions apply; ABD deeming rules do not apply. QUALIFYING EVENT:

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Page 1

Official source

COMBINED MEDICAID 307-1 Cobra 75 Supersedes: FMA 308-1 (01/01/08); MA 305-4 (07/01/05) Reference: 26 CFR 54.4980B-7. ARM 37.82.101, .430 Overview: When cost effective, COBRA 75 Continuation health plan premiums are paid for individuals who are not Medicaid eligible, but who meet COBRA 75 non-financial and financial guidelines. TPL administers health insurance premium payments. COBRA 75 applicants have only a 60 day window of opportunity to establish continued participation in a health care plan they would otherwise lose due to a qualifying event. NONFINANCIAL REQUIREMENTS: The following nonfinancial eligibility criteria must be met: 1. citizenship or alienage; 2. state residency; 3. Social Security number; and 4. Are eligible to receive continued health plan coverage through an employer with at least 75 employees because of a qualifying event. NOTE: Applicants do not have to meet categorical (i.e., aged, blind, disabled, pregnant, etc.) eligibility criteria. FINANCIAL REQUIREMENTS: Countable resources cannot exceed: 1. $4,000 for one individual; or 2. $6,000 for a family with two or more people. Countable monthly income cannot exceed 100% of the federal poverty guidelines based on family size. NOTE: Appropriate ABD (Aged, Blind, Disabled) Medicaid income disregards and exemptions apply; ABD deeming rules do not apply. QUALIFYING EVENT: