Department of Personnel and Administration

 

Welcome to the State of Colorado
Medical Premium Supplement
Application Site

 
  To apply for the FY 2014-15 Medical Premium Supplement you must meet the following criteria:  

Checkmark You must fall at or under the annual income maximum for the size of your household (see below). Your household includes ALL people in your home including those not eligible for or enrolled in a State of Colorado benefit plan.

Checkmark You must be enrolled, or willing to enroll, yourself and your legal, dependent child(ren) in a State of Colorado medical plan.

Checkmark At the time of application, you must be able to upload, in electronic format (.pdf, .jpg) the required documents.

There is NO guarantee that you will receive the supplement as the money is awarded based upon demonstrated need. For those that receive a supplement there is NO guarantee that the supplement will cover 100% of your premium, or any set percentage, or when the supplement will be received.

Please Note: Effective January 1, 2013, Children of State of Colorado employees became eligible to enroll in CHP+. CHP+ may be free for children under 18, depending on your monthly income. www.chpplus.org.

Currently, DPA does not have information about the total amount of money that the State of Colorado will receive to supplement lower income families for FY 2014-15.

Maximum Levels for Annual Household Income to be Eligible for the FY 2014-15 Supplement Program.
(Household income is for ALL people in your home, not just the employee. It is the total income, as indicated on the line 22 of 1040, line 15 of 1040A, or line 4 of 1040EZ, for all earners who filed a 2013 Federal Income Tax return.)

Household
Members
Annual Income
Maximum

2 $46,530
3 $58,590
4 $70,650
5 $82,710
6 $94,770
7 $106,830
8 $118,890
9 $130,950
10 $143,010
11 $155,070
12 $167,130
13 $179,190

For each additional person in the household over 13, add $4,020 to attain the limit under which you must fall.



Division of Human Resources – 1525 Sherman Street, 2nd Floor – Denver, CO 80203 – Phone: 303-866-3434 – Fax: 303-866-3879

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