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UPDATED: AUGUST 1999

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INCOME SSI-RELATED BUDGETING METHODOLOGY

HEALTH INSURANCE PREMIUMS

Description: Health insurance premiums are premiums paid for insurance which covers hospital, medical, dental, drug and/or other charges for medical care and services.

Policy: In determining eligibility for SSI-related persons, health insurance premiums are deducted if they are paid by the A/R.

References: SSL Sect.

366.2(a)(6)

Dept. Reg.

360-4.6(a)(2)(vii)

ADMs

93 ADM-28 91 ADM-54 91 ADM 53 91 ADM-27

Interpretation: Health insurance premiums are deducted from the kind of income from which they are being paid. If it is not possible to determine if the health insurance premiums are paid from earned or unearned income, the deduction is made where it is most advantageous to the client.

Health insurance policies, which indemnify the A/R against charges for medical care and services, are considered for this disregard. These include: Medicare Parts A & B, Blue Cross, Blue Shield, Major Medical insurance, dental insurance, prescription drug insurance, long term care insurance, union health fund premiums, and other hospital and medical insurance.

Policies, which indemnify the A/R against loss of income due to illness or disability, may be considered for this disregard. These include: income protection insurance, medical liability insurance and any other insurance which offsets the loss of wages due to illness or hospitalization. A policy, which pays the A/R a certain amount of money for each day s/he is hospitalized, but does not cover specific hospital services, may be eligible for this disregard. The policy must be assignable (See RESOURCES THIRD PARTY RESOURCES ASSIGNMENT AND SUBROGATION) to a hospital and be cost effective for its premiums to be considered as a deduction. A policy belonging to a non-applying spouse does not have to be assignable in order to receive the premium disregard.

(MRG)