2016 2017 Every Penny Counts Guidelines For

2016 – 2017 Every Penny Counts Guidelines for Health Insurance Premium Assistance EPC PO Box 582943 Minneapolis, MN 55458 612-331-7733 or 1-800-565-9028 612-341-3804 - fax

Every Penny Counts Health Insurance Premium Assistance program has limited financial assistance that can assist low-income (at 300% or below federal poverty guidelines - see income guidelines), HIV positive Minnesotans who require financial assistance to maintain their health care coverage, insurance deductibles and/or co-pays. The Health Insurance Premium Assistance program will pay any health insurance premium (ie: Minnesota Care, MCHA, Medicare supplement insurance, private insurance, etc) with priority given to assistance with insurance premiums. Eligible individuals may receive up to $100 per program funding year (April 1, 2016 – March 31, 2017) for health insurance premiums, insurance deductibles, or co-pay assistance. This assistance is in addition to the $390 assistance available for individuals with household incomes at or below 200% of the federal poverty guidelines for assistance with rent, utilities, medical expenses, and food. How to apply: 1. Complete an Every Penny Counts application (both sides). A new application must be completed each program year (April 1, 2016 – March 31, 2017). If you request assistance more than once during the program year and have a current application on file, you do not need to complete another application for any additional request for assistance. 2. If this is the first time you are applying for assistance, please provide written verification of HIV-positive or AIDS status signed by a licensed health care professional. 3. Attach proof of the income you report on the application such as: most recent paystub (within the last 30 days), 2015 tax return, benefit statement such as Social Security award letter, MFIP award letter, bank statement, certification of zero income form or affidavit, or a MN-ITS printout of enrollment in Program HH qualify for income verification for the EPC Health Insurance Premium Assistance program. Without income documentation we will be unable to provide assistance. Please note that we need to collect updated income verification from clients every 6 months. 4. Submit a copy of your health insurance premium coverage notice, insurance deductible bill and/or co-pay that you want paid. 5. There will be very limited financial assistance allotted per month for premiums, insurance deductible and co-pays. Depending on the demand for assistance for health insurance premiums/deductibles/co-pays a monthly lottery may be established; and, once the allotted monthly funding has been paid out, no further assistance will be available until the following month. Health insurance premiums will be given priority over insurance deductibles and co-pay assistance. 6. Every Penny Counts requires a minimum of 3 business days to process premium payments. EPC will make assistance payments directly to the health insurance premium provider and/or appropriate vendor. You will be notified only if your health insurance premium/deductible/co- pay will not be paid for. Requests for assistance that were not selected in the lottery will not be carried over to the next month. You may request to have your request resubmitted for the following month’s lottery.

7. In order to qualify for assistance, applicants must meet all eligibility requirements. This service is funded by the federal Ryan White HIV/AIDS Treatment Modernization Act, Part A or B.

8. After initial application you only need to send in your current health insurance premium coverage notice, insurance deductible or prescription co-pay invoice for payment consideration.

PLEASE NOTE: Please call our voicemail and leave a detailed message if you have questions. We will usually return your call within one (1) working business day. The Every Penny Counts voice mail greeting is updated after ever lottery to reflect the status of the lottery, the availability of funding, and when the next lottery will occur. Every Penny Counts Emergency Assistance has a grievance policy, contact the MAP AIDSLine for further information. During the grant period/year, program guidelines and the amount of funding allowed individuals is subject to change based on needs and/or the availability of funding. A notice will be sent to providers and a message will be recorded on the Every Penny Counts voicemail of any changes that occur.

INCOME GUIDELINES FOR EVERY PENNY COUNTS EMERGENCY ASSISTANCE (effective April 1, 2016) 2016 Federal Poverty Guidelines (300%) Family Size Gross Annual Income Gross Monthly 1 $35,640 $2,970 2 $48,060 $4,005 3 $60,480 $5,040 4 $72,900 $6,075 5 $85,320 $7,110 6 $97,740 $8,145 7 $110,190 $9,183 8 $122,670 $10,223 For family units with more than eight members, add $12,480 for each additional member to annual income. “Family Unit” is defined as all people living together that are legally dependent on the income. Income for all members of the “family unit” will be considered for these guidelines and must be submitted with application.