Effective Date: May 1, 2024

Previous Policy

A. Benefits

This program provides a reimbursement for all or part of the insurance premium paid by an employee for an employer-sponsored health insurance plan or COBRA that covers the employee, their spouse and/or children. (See 1007 for reimbursement effective dates.)

1. For medical insurance, the reimbursement for each eligible person will not exceed the maximum allotment per person. The combined amount for all eligible members cannot exceed the actual premium cost. The only exception is when a child is receiving an additional payment for dental. The maximum allotments are:

a. $300.00 for each adult.

b. $180.00 for each child.

2. If the employer offers dental insurance, or it is available through COBRA, families will receive an additional payment of $20.00 for each child to pay for this coverage if the children are enrolled in the dental coverage. The actual cost of the dental insurance does not matter. If there is no employer-sponsored dental insurance available, or the children are not enrolled in the employer-sponsored dental coverage, each child will receive a dental benefit through the CHIP program.

3. A check for the amount of the reimbursement will be sent to the household within 2 weeks of the first of the month. If more than one person is eligible, only one check will be sent for the combined amount.

4. Continue the UPP reimbursement during a due process month(s). (See Glossary and 1008-1 )

B. How to Calculate a Reimbursement

1. To calculate an UPP reimbursement, take the total monthly premium and divide this by the number of UPP eligible household members.

a. If the calculated amount is less than the maximum allotment for each eligible household member, each member will receive the calculated amount.

b. If the calculated amount is more than the maximum allotment for each eligible household member, each member will receive the maximum allotment amount.

2. To allow for a maximum reimbursement, it may be necessary to complete an additional calculation.

3. If the calculated amount is less than the maximum allotment for an adult but more than the maximum allotment for a child follow the steps below.

· The eligible child(ren) will receive the maximum allotment of $180.

· The total amount the child(ren) receive(s) will be subtracted from the total monthly premium amount.

· The remaining amount will be divided by the eligible adults, they will receive that amount or the maximum allotment, whichever is less.

Examples

Example 1: Family of 5, 2 parents and 3 children, cost of the family plan is $500. All household members are eligible for UPP. To calculate the reimbursement, divide the total premium cost of $500 by 5. This is less than the maximum amount, so each household member is eligible for a full reimbursement of $100.

Example 2: Family of 4, 2 parents and 2 children. Policy holder’s cost is less than 5% making them ineligible for an UPP reimbursement. Cost of the family plan is $600, divided by the 3 eligible household members totals $200.00 each. Since this is more than the maximum allotment for children, each child will receive $180 for a total of $360. Subtracting $360 from $600 equals $240, which is less than the maximum allotment for adults. The adult is eligible for $240 making the total reimbursement $600.

Example 3: Family of 3, 2 parents and 1 child, the mother is currently receiving benefits on the pregnant woman program. Cost of the family plan is $500, divided by the 2 eligible household members totals $250 each. Since this is more than the maximum allotment for a child, they will receive $180. Subtracting $180 from $500 leaves an amount of $320, which is more than the maximum allotment for one adult. The adult is eligible for $300 making the total reimbursement $480.

Example 4: Family of 6, 2 parents and 4 children, the children are receiving Medicaid under a child medical program. The employee has decided to double cover the children and enrolled in the family plan. The family plan cost is $500, divided by the 2 eligible household members totals $250 each. Since this is less than the maximum allotment for adults, each will receive that amount for a total reimbursement of $500.

Example 5: Family of 4, 1 parent and 3 children, all household members are eligible for UPP. Cost of the family plan is $900, divided by the 4 eligible household members totals $225 each. Since this more than the maximum allotment for each child, they will each receive $180. Subtracting $540 from $900 leaves an amount of $360, which is more than the maximum allotment for one adult. The adult is eligible for $300, making the total reimbursement $840.