Utah Premium Parthnership for Health Insurance
UPP (Utah's Premium Partnership for Health Insurance) helps make health insurance more affordable for working individuals and families who do not currently have health insurance. UPP (pronounced ‘up’) helps you pay your monthly health insurance premiums through your employer’s health insurance plan.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
   
   
  1. What's UPP?
  Utah’s Premium Partnership for Health Insurance (UPP) is a program of the Utah Department of Health. UPP (pronounced “up”) helps make health insurance more affordable for individuals and families.

UPP is for adults and children who do not currently have health insurance or enroll in COBRA coverage.
 

• UPP will help you pay your monthly premiums when you enroll in your employer’s health insurance plan or COBRA
• You or your dependents may qualify for UPP based on family size, income, and if your employer’s health insurance plan or COBRA coverage meets basic guidelines
• If you or your dependents qualify, UPP will reimburse you up to $150 per adult and up to $120 per child in the family--every month!

 
 
 

2. How does UPP work?

 
UPP helps make health insurance more affordable for individuals and families. Basically, here’s how it works:
 
• First, you must apply for UPP BEFORE the date that your health insurance coverage begins (your employer health plan). If you are already enrolled in COBRA you may apply at any time.
• UPP will contact you within two weeks from receiving your application.
• Pay your monthly premiums.
• If you qualify for UPP, you will need to provide proof you have enrolled and show how much you pay in premiums.
• Then, UPP will reimburse you up to $150 per adult and up to $120 per child every month to share in the cost of your monthly premiums. A check will be mailed to you each month.
• In addition, you may be eligible to receive an additional $20 per child if he/she is enrolled in dental coverage. (Every eligible child will receive an additional $20 each month to pay for dental coverage or be enrolled in the Children’s Health Insurance Program dental plan).
 
   
 
3. Who is eligible?
 
Utah adults and children are eligible—children age 18 and under, and adults ages 19-64 who fit within the income guidelines. See #4Do I qualify?”
 
 
 
4. Do I qualify?
 
There are several factors that are used to determine eligibility.
  Adults age 19-64 may qualify if:
 

• You are not covered by health insurance right now
• You or your spouse is employed
• The company you or your spouse works for offers health insurance
• You are a U.S. citizen or legal resident
• You fit within the income guidelines for adults
• The cost of the least expensive health insurance option is more than 5% of your total household income (before taxes)

You may also call your local office for more information.

 
 
 
5. Does my child qualify?
 
Children ages 0-18 may qualify if:
 

• Child is not covered by health insurance right now
• Child is a U.S. citizen or legal resident
• You or your spouse is employed
• Your company (or your spouse’s company) offers health insurance
• You are eligible to get health insurance through your job (or your spouse’s job) for your child
• Your family’s income fits within the income guidelines for children
• The cost of the least expensive health insurance option is more than 5% of your total
household income (before taxes)

You may also call your local office for more information.

 
   
  6. What are the income guidelines?
 

To qualify for UPP, you must meet the income guidelines explained in the chart. Income includes the following: wages that you and your spouse earn, child support, alimony, Social Security, etc.

We know there are many rules regarding income, and it’s hard to remember them all. So just fill out your application the best you can and UPP will contact you if there are any questions. You may also call your local office for more information.

Maximum Income Per Month
(Before Taxes)*
Family Size
PER MONTH

PER YEAR

1
$1,915
$22,980
2
$2,585
$31,020
3
$3,255
$39,060
4
$3,925
$47,100
5
$4,595
$55,140
6
$5,265
$63,180
7
$5,935
$71,220
For each additional family member
Add $670 per
month
Add $8,040 per
year

*Effective March 1, 2013

 
   
 
7. How do I apply?
  Follow these steps if you have health insurance offered at work:
   
  1. Ask your employer if you are eligible to get health insurance through them.
2. Apply for UPP BEFORE the date that your health insurance coverage begins.
3. Follow these steps to apply:
 

Apply for UPP. Apply online OR download and return the UPP Application.
Have your employer fill out and return the
Employer’s Health Insurance Form. (included in the application)

 

- The Employer’s Health Insurance Form must be
completed by your employer or your company’s
Human Resources representative.

- This form must be completed for each employed household member.
- If you need extra forms, you may
download the Employer’s Health Insurance Form.
- Have your employer or Human Resources representative return the form as soon as possible.
Mail: UPP, PO Box 143245, SLC, UT 84114-3245
Fax: 1-877-313-4717.

 

•After 2 -3 business days, you may call DWS at 1-866-435-7414 to complete your interview and/or to find out what verifications are needed to determine your eligibility. You may also go to MyCase for more information and to view the status of your case.

   
  Follow these steps if you have COBRA coverage or are eligible for COBRA:
   
 
  1. Find out if you are eligible to get COBRA health insurance. If you are already enrolled in COBRA, go to step 2.
  2. Apply for UPP. Apply online OR download and return the UPP Application
  3. Have your previous employer or your COBRA insurance company fill out and return the COBRA Health Insurance Information form as soon as possible:
 

Mail: UPP, PO Box 143245, SLC, UT 84114-3245
Fax: 1-877-313-4717.

 

After 2 -3 business days, you may call DWS at 1-866-435-7414 to complete your interview and/or to find out what verifications are needed to determine your eligibility. You may also go to MyCase for more information and to view the status of your case.

  Back
 
 
8. When is it time to get UPP?
 

It’s time to get UPP if:

  • You and/or your family are not currently enrolled in your employer-sponsored health insurance,
  • If you have begun a new job.
  • If you are eligible for COBRA
  • If you are already enrolled in COBRA coverage

If you have health insurance offered at work and are not yet enrolled, you must apply for UPP BEFORE the date that your health insurance coverage begins. If you’re eligible to add your spouse or your child(ren) to your health insurance, then it’s time for them to get UPP, too.

As of July 1, 2008 approval for UPP is also considered a qualifying event for applicants to enroll in their employer-sponsored health insurance plan at any time. Applicants do not have to wait for the annual open-enrollment to enroll, if approved for UPP. For more information call 1-888-222-2542 or click here.
 
 
 
9. What will my costs be?
 
If you are enrolled with UPP, you must pay your monthly premium for your employer's health plan or COBRA coverage. You are also responsible for paying co-pays or co-insurance as required by your health plan. In return, UPP will reimburse you up to $150 per adult and up to $120 per child.

Example: Household has one parent and two children
Health Plan’s total premium = $400/month for the whole family
UPP reimbursement = $150 (1 adult) + $240 (2 children) = $390/month
Your total cost = $10 + any co-pays, co-insurance and deductibles

 
 
 
10. I have health insurance, but my spouse doesn’t. Can he/she qualify for UPP?
 
Yes, it is possible that your spouse may qualify for UPP if he/she can enroll in your employer’s health insurance plan or COBRA coverage.
 

• If your spouse is age 19-64, see See #4 Do I qualify?
• If your spouse is age 18 or younger, see See #4 Does my child qualify?

 
For your spouse to apply:
Follow the same guidelines. See #7 How do I apply.
 
 
 
11. My child is on CHIP, can he/she get UPP?
 
Yes. It’s possible your child may qualify for UPP. If he/she qualifies, your child may switch from CHIP to UPP. Also, your employer’s health insurance plan or COBRA coverage must meet basic guidelines. See #14 Does my employer’s health insurance plan qualify for UPP?

We encourage you to compare the benefits, co-pays and health insurance premiums between CHIP and your employer’s health insurance plan or COBRA coverage. See the Comparison Chart to decide which option is best for you.

To get UPP, please contact your case worker. He/she will be able to give you the necessary forms.

 
 
 
12. I am on PCN. Can I get UPP?
 
Yes. It’s possible you may qualify for UPP. If you qualify (see #4 Do I qualify?) you may switch from PCN to UPP. Also, your employer’s health insurance plan must meet basic guidelines. (see #14 Does my employer’s health insurance plan meet UPP guidelines.)

To get UPP, contact your case worker. He/she will be able to give you the necessary forms you need to fill out.

 
 
 
13. Is there a limit to how many people in my family can use UPP?
 
No. There’s not a limit. If you qualify, you may receive up to $150 for each adult in your family and up to $120 for each child in your family, no matter how many people are in your family.

Example: Household has two adults and five children
Health Plan’s total premium = $800/month for the whole family
UPP reimbursement = $300 (2 adults) + $480 (4 children) = $780/month

 
 
 
14. Does my employer’s health insurance plan or COBRA coverage qualify for UPP?
 

Your health insurance plan must meet these guidelines:

  • Cover physicians visits, well child exams, hospital inpatient services, child immunizations, and pharmacy
  • Employer must pay at least 50% of the cost for the employee’s coverage for health insurance offered at work (employer sponsored health insurance only)
  • Have a deductible of $2,500 per person (or less)
  • A lifetime maximum of $1,000,000 (or more)
  • Plan pays at least 70% of inpatient costs after the deductible
  • The plan does not cover any abortion services; or the plan only covers abortion services in the case where the life of the mother would be endangered if the fetus were carried to term or in the case of rape or incest.
 
 
 
15. What about dental coverage?
 
There are two options for your children to get dental coverage:
• Get dental coverage through CHIP, or
• Get dental coverage through your employer and receive an additional reimbursement of $20 per child every month

Options for dental coverage are only for individuals age 18 and under.
 
 
 
16. I turned in my application. When will I know if I can get UPP?
 
After 2 -3 business days, you may call DWS at 1-866-435-7414 to complete your interview and/or to find out what verifications are needed to determine your eligibility. MyCase for more information and to view the status of your case. It may take 4 – 6 weeks to process your application. If there are parts of the application that are incomplete, the process will take longer.
If you have any questions, call 1-866-435-7414 or click here to chat online with an eligibility worker (click on the Online Help yellow computer mouse). You may also e-mail.

 
 
 
17. What is the next step after qualifying for UPP?
 
  1. Send proof that you are enrolled in a health plan.

    Send a copy of your paycheck stub. Once you are enrolled with UPP and your employer health plan, send UPP a copy of your paycheck stub showing that the cost of the health insurance coverage was withheld.


    Send a copy of your COBRA coverage award letter.
  2. UPP will send you a reimbursement check. Your check will arrive in the mail during the first two weeks of each month. Make sure UPP always has your current address to avoid delays.
  3. Your continuing eligibility is based on the fact that you remain covered on your UPP qualified medical insurance plan.  Please report the following changes for UPP:
      • Change in health plan (premiums, deductibles, coverage, insurance company, etc.)
      • Change in household members covered under the plan.
      • Termination of health insurance.
      • Enrollment in any other health insurance plan, including COBRA.
  4. We will be checking on your insurance every quarter.  If we are unable to verify your insurance coverage, you will be asked to provide verification.  If this is not provided in the time period give, your UPP assistance will be closed.
 
 
 
18. How do you verify that a person has health insurance?
 
Your employer or COBRA representative sends UPP the verification form, which lists who is covered. You may be asked to provide proof of premium payment. UPP may contact your health insurance company to ensure you remain covered.
 
   
 
19. How long can I be on UPP?
 
You can be on UPP, as long as you are insured, report all changes in your information to UPP, and continue paying your health insurance premium. You must also renew eligibility every year. How do I renew?
 
 
 
20. Can I upgrade to a better insurance plan?
 
Yes. You can choose the plan you want to be reimbursed for, as long as you qualify for UPP using the least expensive plan offered.
 
   
 
21. How do I renew?
 
Every 12 months from the time you enrolled, UPP reviews your enrollment. At that time, UPP will mail you a renewal form. Fill out the form and return it to your eligibility worker as soon as possible.
 
   
 
22. How is UPP funded?
 
UPP is funded with state and federal money.
 
 
 
23. How do employers benefit from UPP?
 
Employers have an advantage to using UPP because it increases participation in group coverage. Health insurance carriers require a certain percentage of employees to participate in coverage in order for an employer to offer group coverage.

And, health benefits help employees increase productivity and miss fewer days or work. If an employee has health insurance through their job, they’re more likely to stay.

 
   
 
24. How can employers let their employees know about UPP?
 
Employers can provide new employees with an UPP brochure in their new-employee information packet. Employers can also include an UPP brochure with the information packet during the annual open enrollment period for the health insurance plan. If you’d like to order brochures or any other UPP materials, call 801-538-6847 or e-mail upp@utah.gov.

 
 
 
25. I am moving to another state. Do other states have a program like UPP?
 
Yes. So far, these states have a similar program: California, Georgia, Idaho, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Missouri, Montana, New Jersey, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Virginia, West Virginia, and Wisconsin.

However, eligibility rules are different for each state. Please refer to each state for more information.

 
   
 
26. I am a reporter. Who do I call if I have more questions?
 
Please be prepared to give us your full name, organization you are with, and media related questions you have.
801-538-6847
 
 
 
27. My question isn’t answered here. Who do I call if I have more questions?
 
If you have questions that are not answered on this Web site, call 1-888-222-2542 or e-mail upp@utah.gov
 
 
 

28. I want to order materials. Who should I contact?

 
To order materials (min. qty. 25) for your organization, please e-mail upp@utah.gov with your request and mailing address.
 
 
 
29. I didn’t receive my UPP check, what should I do now?
 

Check with your eligibility worker by calling 1-866-435-7414 or go here to verify that your UPP case is still open.  If your case is still open and it is after the 12th of the month, then you will need to complete the “Lost Check Replacement Form” and return the form to:

Department of Health
Bureau of Eligibility Policy
UPP
PO Box 143107
Salt Lake City, UT 84114-3107

Or fax completed form to: (801) 538-6952



Or Fax to (801) 538-6952

 
   
 
30. Will my medical information be stored and accessed through the cHIE?
 

Medical assistance (Medicaid, CHIP, UPP, PCN) recipients are automatically enrolled in the Utah Clinical Health Information Exchange (cHIE). The cHIE provides a safe place for participating healthcare providers to share and view patient medical information.
Once your consent status has been set to PARTICIPATE, it will remain in effect for five years or as long as you are enrolled in PCN or Medicaid. You have the right to not participate in the cHIE or to change your consent status at any time. For more information or to opt out of cHIE participation, visit My cHIE or talk to a healthcare provider.