Effective Date: February 1, 2021

Previous Policy

The following may be eligible for UPP:

Individuals who have access to or who are covered by COBRA.

Individuals who have access to employer sponsored insurance (ESI) but have not yet enrolled ( 1003-1 ).

Individuals are enrolled if they have signed up for the plan and they are receiving benefits under that plan.

If the individual is able to complete the enrollment process within 90 days of the application date or is in the waiting period, they may be found eligible for UPP. However, they cannot begin to receive an UPP reimbursement until the month they pay a health insurance premium.

An individual enrolled in a FFM plan may be found eligible for UPP, if they now have access to employer sponsored insurance. Coordinate enrollment in UPP with the termination of the FFM plan. Individuals enrolled in an individual health insurance plan that is not through the FFM are not eligible unless they meet an exception ( 1003-11 ).

An individual who was enrolled in Adult Expansion and is now ineligible for the program, can receive UPP under the following conditions:

They were receiving an ESI premium reimbursement with Adult Expansion; and

There was no break in coverage moving from Adult Expansion to UPP; and

The plan is an UPP qualified health plan.

The UPP payment cannot begin until the month following the closure of the Adult Expansion program.

The following individuals would not be eligible for UPP and are not eligible for a reimbursement.

Individuals who are enrolled and currently receiving benefits in an employer-sponsored health plan:

Through their employer;

Their spouse’s employer; or

Their parent's or legal guardian's employer.

Individuals who are enrolled in Medicare Part A or Part B.

Individuals who are enrolled in health insurance coverage through the Veteran's Administration Health Care System.

Individuals who are enrolled in a student health insurance plan.

Individuals who are enrolled in any other type of group health insurance plan that is not considered limited coverage ( 1003-1 ).

Exceptions:

See Section 1009-5 for exception .

Individuals completing their review within 3 months of a review closure ( 1008-2 ) .