Premium Assistance Program

UA offers premium assistance to benefit-eligible employees by giving a medical premium discount based on (1) family size and (2) total combined household income set at 1.5x the Federal Poverty Level. To apply for this discount, benefit-eligible employees must submit the Premium Assistance Application and furnish acceptable proof of total annual household income based on their most recently filed Federal Income Tax Return, W-2s and 1099s.

Application Deadlines:

  • Current Employees – Submit documentation annually during Open Enrollment.
  • Newly Eligible Employees – 30 days from the effective date of enrollment in health plan.

The amount of the discount provided is equal to the lowest cost single plan employee premium offered. For 2019, the amount is $54 per month (up to $648 per year) and this will increase to $57 per month (up to $684 per year) in 2020. The discount is available for employees covered by either health plan option, the PPO or HDHP.

After receipt and approval of the application, the premium discount will be effective based on the medical plan effective date and will be reflected in the first available paycheck. The discount only applies to medical plan enrollment and is for the current plan year only. Employees must reapply each plan year during Open Enrollment.

Estimate your eligibility for the discount using the federal poverty level table below:

2019 Premium Assistance (1.5 x 2018 Federal Poverty Level)
Family Size Total Annual Household Income
1 $18,210
2 $24,690
3 $31,170
4 $37,650
5 $44,130
6 $50,610
7 $57,090
8 $63,570
2020 Premium Assistance (1.5 x 2019 Federal Poverty Level)
Family Size Total Annual Household Income
1 $18,735
2 $25,365
3 $31,995
4 $38,625
5 $44,255
6 $51,885
7 $58,515
8 $65,145


Premium Assistance Application Instructions

1. Complete the required Application Form and submit the form to the HR Service Center by email or fax to 205-348-8755, or deliver to 1001 Human Resources Administration Building located at 1670 Ruby Tyler Parkway.

2. Submit all required documentation (Federal Income Tax Return, W-2s and 1099s) online in the BenefitFocus portal OR deliver in-person to the HR Service Center located in 1001 Human Resources Administration Building. Please blacken out any Social Security Numbers.

3. Your application will be reviewed by a Benefits Specialist, then you will be notified of your approval or denial via your official UA email address.