2013 Medical Premium Relief Program

The University has extended the 2012 Medical Premium Relief (MPR) grant program until June 30, 2013. This grant extension will be prorated and payable over 13 pay periods as a medical premium credit.

Grant amounts range from $100 to $225 as shown on the coverage tier chart.

If you are enrolled in the 2012 MPR program, your eligibility will automatically roll over to the 2013 MPR program after your medical enrollment and coverage tier are verified. You do not need to re-apply for 2013. If verification reveals that your coverage status has changed, you will be contacted and allowed to apply for the 2013 program, if applicable.

If you are enrolled in the 2012 MPR Program and your 2011 income is less than in 2010, it may be beneficial for you to apply for the 2013 program. You may qualify for a higher relief amount.

If you qualified for the 2012 program, but did not apply, you can still apply for the 2012 Program and start receiving the relief as soon as administratively possible, pending approval.

If you qualify for the 2013 MPR program, based on your 2011 household income, you must apply and be approved to get the 2013 premium credit amount.

The application deadline is December 17, 2012, for submitting an application for 2013. Applications received after this date will not be processed.

2012 and 2013 Program Qualification

To apply, please submit the following tax documents and application to Employee Benefits:

1. Medical Premium Relief for Lower Income Employees application (pdf) with signature
2. Either:
   • 2010 Federal Tax Form (2012 Program Qualification)
   • 2011 Federal Tax Form (2013 Program Qualification)

The line on the 2010 and 2011 applicable tax form used to determine premium credit:
Form 1040, Line 22. Form 1040A, Line 15. Form 1040EZ, Line 4.

Medical Premium Relief for Lower Income Employees application (pdf) with signature

	Qualifies for $225	Qualifies for $200	Qualifies for $175	Qualifies for $150	Qualifies for $125	Qualifies for $100
Coverage Tier as of 1/1/2013	Gross Household Income
Employee Only	N/A	N/A	N/A	N/A	N/A	$35,000
Employee + Spouse/SSDP	$42,500	$45,000	$47,500	$50,000	$52,500	$55,000
Employee + Child(ren)	$32,500	$35,000	$37,500	$40,000	$42,500	$45,000
Employee + Spouse/SSDP + Child(ren)	$52,500	$55,000	$57,500	$60,000	$62,500	$65,000