University of Minnesota
Office of Human Resources
http://www.umn.edu/ohr
612-625-2016

2014 Medical Cost Relief Program

In order to help families who may be struggling financially due to rising medical costs, the University has established a new, one-year Medical Cost Relief Program for 2014. Employees qualify for the program based on their tier of UPlan Medical coverage and their household income from the 2012 federal tax form.

Grant amounts range from $100 to $500 as shown on the chart below, and these payouts will be considered taxable income to you. The grant amount will be prorated and payable over 26 pay periods as a medical cost credit, beginning with the first full pay period in 2014.

The final application deadline for the program is December 17, 2013. Eligibility and acceptance for past medical relief programs does not automatically quality an employee for this new program. Please apply by the deadline by submitting the following documents to Employee Benefits:

1. Application for 2014 Medical Cost Relief Program with signature 

2. 2012 Federal Tax Form. The line on the 2012 applicable tax form used to determine credit:

Form 1040 — Line 22. Form 1040A — Line 15. Form 1040EZ — Line 4

Any applications received after December 17, 2013, will not be processed.

Please use the numbers in the chart below to determine the dollar amount for which you may qualify.


Employee Only Tier (as of 1/1/2014)
Gross Household Income Below: $35,000
Qualifies For: $200

Employee+Child(ren) Tier (as of 1/1/2014)
Gross Household Income Below: $25,000 $27,500 $30,000 $32,500 $35,000 $37,500
Qualifies For: $450 $400 $350 $300 $250 $200

Employee+Spouse/SSDP Tier (as of 1/1/2014)
Gross Household Income Below: $32,500 $35,000 $37,500 $40,000 $42,500 $45,000
Qualifies For: $500 $450 $400 $350 $300 $250

Employee+Spouse/SSDP+Child(ren) Tier (as of 1/1/2014)
Gross Household Income Below: $40,000 $42,500 $45,000 $47,500 $50,000 $52,500
Qualifies For: $350 $300 $250 $200 $150 $100

Example: During 2013 Open Enrollment, John enrolled in a UPlan medical plan in the Employee plus Spouse/SSDP tier, with coverage effective 1/1/2014. His 2012 jointly filed federal tax return states a gross income of $39,000. Since this amount is below $40,000, but above $37,500, John qualifies for $350.

The Medical Cost Relief Program is a new program starting in 2014. Eligibility and acceptance in past medical relief programs does not automatically qualify an employee for this program.