Premium Information
(SRS Form ES-3165)
Click here to download the 3165 Working Healthy premiums form (in English).
There is a monthly premium charge for Working Healthy medical
coverage when net income is between 100% and 300% of the federal
poverty level; however, some income is disregarded in calculating
the premium (see
below). The following chart lists the income breakdowns for
the monthly premium charges.(updated May 2009)
PREMIUM CHART FOR WORKING HEALTHY PROGRAM
| Monthly Net Income | Monthly Premium |
|---|---|
| 0.00-903 | 0.00 |
| 903.01-1129 | $55.00 |
| 1129.01-1354 | $69.00 |
| 1354.01-1580 | $83.00 |
| 1580.01-1805 | $97.00 |
| 1805.01-2031 | $110.00 |
| 2031.01-2257 | $124.00 |
| 2257.01-2482 | $138.00 |
| 2482.01-2708 | $152.00 |
| greater than 2708 | NOT ELIGIBLE |
| Monthly Net Income | Monthly Premium |
|---|---|
| 0.00-1215 | 0.00 |
| 1215.01-1518 | $74.00 |
| 1518.01-1822 | $93.00 |
| 1822.01-2125 | $112.00 |
| 2125.01-2429 | $130.00 |
| 2429.01-2732 | $149.00 |
| 2732.01-3036 | $168.00 |
| 3036.01-3339 | $186.00 |
| 3339.01-3643 | $205.00 |
| 2 person household greater than 3643 | NOT ELIGIBLE |
| 3643.01-4578 (3 person household) | $205.00 |
| 3 person household greater than 4578 | NOT ELIGIBLE |
How to Calculate Your Net Income
You can figure your net income using the following steps:
- Add all of your gross earnings (amount before taxes) and divide by two.
- Add all of your monthly unearned income, such as Social Security or Veterans benefits and subtract $20.00.
- Add the amounts from steps 1 and 2.
- Take that total amount and look at the chart to see if your family's income would have a Working Healthy premium charge.
Single persons without a spouse should use the single coverage column. If you are living with a spouse, his or her income must also count toward the total net income. Follow the same steps to determine his of her income, add it to your net income, but now use the two/three person column to determine the monthly premium amount. The two/three person column also applies when an application is filed for a 16 or 17 year old child living with his or her parent(s).
Once you know your monthly net income and this income amount shows you probably will have monthly premium, you can now decide whether or not to continue the application process for Working Healthy.
It is also important to note that there are additional disregards called Impairment Related Work Expenses (IRWEs)and Blind Work Expenses (BWEs). IRWEs are those expenses incurred as a result of working with a physical or mental impairment. The following are examples of expenses that are considered IRWEs:
- Specialized transportation;
- Drugs or other medical expenses not covered by Medicaid or other insurance;
- Service animal expenses such as obtaining animal food, licenses and vet bills.
For IRWEs the first $100.00 of reported earned income is exempt. If expenses exceed $100.00, additional expenses are allowed with proper documentation and receipts. If the expenses do not exceed $100.00 receipts are not required. IRWEs must never exceed the amount of a persons' total earned income.
Blind Work Expenses (BWEs) are reasonable, allowable expenses that are related to earning income for individuals who are blind. Examples of BWE's include but are not limited to the following:
- Service animal expenses;
- Transportation to and from work;
- Visual aides and translation services;
- Costs of training to use specialized equipment related to the disability.
For BWEs the first $300.00 of reported earned income is exempt. If expenses exceed $300.00, additional expenses are allowed with proper documents and receipts.
If you have questions about your possible work related expenses and exemptions please contact your local Benefits Specialist.
Click here to download a "Working Healthy Premium Calculator" worksheet to figure out what your premium might be!
ONE EXAMPLE:
Joe is a single person who receives gross monthly Social Security Disability benefits of $854.00 and has gross monthly earnings from work of $665.00. Joe now determines what his premium would be if he applied for Working Healthy:
- Social Security Disability (unearned income) = $854.00
- Earned income = $665.00
Steps:
- Earned income disregard (first $65.00 of earned income) = $ 65.00 ($665.00 - $65.00 = $600.00)
Earned income disregard (half of remaining earned income) = $ 300.00 ($600 ÷ 2 = $300.00)
After subtracting these disregards from his earned income, Joe's earned income = $300.00 - Joe then subtracts a standard disregard of $20.00 (for all persons except those in nursing facilities) from his unearned income ($854.00-20.00) and his earned income = $834.00
- Joe now adds his adjusted earned income to his adjusted unearned income to arrive at his countable income for Working Healthy - $834.00 + $300.00 = $1134.00
- When Joe's income is compared to the table for a single person assistance plan above, his countable income of $1134.00 falls into the range, $1129.01 - $1354, giving Joe a monthly premium of $69.00.
This example is provided as a guideline for how to figure a premium. However, we encourage you to please contact the Benefits Specialist in your area to discuss what your Working Healthy premium would be.
PREMIUM PAYMENTS AND POLICIES
As of July 1, 2009 HP Enterprise Services is the entity that handles Working Healthy premiums. HP Member Services can be reached toll-free Monday-Friday, 8 am - 5 pm at 1-866-688-5009.
Premiums are now billed on the 1st and 15th days of the month.
Premium payments are due by the last day of the month.
HP offers the following options for monthly premium payments:
- Mail a check or money order to a post office box
- Manage Working Healthy premium bills on the Internet
- Set-up recurring automatic payment
- Make immediate payments online or over the phone
- Pay using drafts from checking/savings accounts (payments will be deducted the 5th day of the month)
PREMIUM BILLING FREQUENTLY ASKED QUESTIONS:
When will I get my premium bill each month?
You will receive your premium bill shortly after the 1st or the 15th of the month.
When is my premium payment due?
Premium payments are due to HP by the last business day of the month.
Where do I send my premium payments?
HP - Kansas Premiums
P.O. Box 842195
Dallas, TX 75284-2195
Do I need to send anything with my payment?
Yes - tear off the payment slip at the bottom of your bill and send it with your payment in the return envelope. Please do not fold the payment slip or your payment. Be sure the "HP Kansas Premiums" address can be seen in the address window of the return envelope.
What if my premium bill is wrong?
Contact HP and discuss your bill. If it is an accounting problem, they will take care of it. If your monthly premium amount is wrong, HP will ask you to contact your SRS eligibility works to have it changed. HP will make the change once your eligibility worker contacts them.
How do I pay my premium?
You have several choices:
1. Mail: Send a check or money order to the payment address above.
2. Go online: You can enrolle in electronic billing to set up an automatic payments and see your statements online at https://express.openbill.com/khpa/enroll.html. HP can take yur payment directly from your checking or savings account if you provide your account information.
3. By Phone: You can make a payment using HP's automated service by calling 1-866-923-2724. To speak with a payment agent you can call 1-866-688-5009.
Who do I call to find out about my eligibility for Working Healthy?
If you have questions about your current coverage or need to request coverage changes, you must contact your SRS eligibility worker.
What if I don't know my SRS Eligibility Worker's name?
The HP representative will give you a toll-free number for the SRS office in your area. You can call that number and ask them to help you get in touch with your worker.
Who do I contact for questions about my bill or to mail in payments?
For questions related to your bill, please call HP Member Services toll-free at 1-866-688-5009, Monday-Friday from 8:00 am to 5:00 pm. Central Time. If you have a hearing impairment, please use the Kansas Relay Service at 1-800-766-3777.
Premium Payment Address:
HP Kansas Premiums
P.O. Box 842195
Dallas, TX 75284-2195
Correspondence ONLY Address (DO NOT MAIL PREMIUMS HERE):
HP Kansas Premiums
P.O. Box 1778
Topeka, KS 66601
To download a 2 page informational sheet containing the premium FAQ listeed above, CLICK HERE