Medicaid Policy                                                                 

348-3.3 How to Calculate an ESI Premium Reimbursement

Effective Date: December 1, 2021

 

No Previous Policy      

 

Once eligibility for an ESI reimbursement has been determined, use the monthly premium amount provided on the 116M/116E for the reimbursement amount. If the monthly amount is not provided, the premium reimbursement will be calculated by an annualized methodology using the formula found below.

  ·       If the individual has already received an UPP reimbursement, the total UPP reimbursement received will need to be deducted from the ESI reimbursement. 

 

Formula:

Method for calculating an ESI Reimbursement:

·       Determine the per check deduction amount for those eligible for a reimbursement,

·       Multiply by the number of checks the deduction will occur in a year,

·       Divide by 12.

 

Example 1:

Step one: The deduction amount is $42; the employee is paid every two weeks but the deduction will only occur twice a month (24 times a year).

Step two: $42 X 24 = $1,008.

Step three: $1,008 ÷ 12 = $84 monthly premium reimbursement.

 

Example 2:

Policy holder is paying for a qualified family plan; the employee and spouse are eligible for an ESI reimbursement.

Step one: The deduction amount for the employee + spouse plan found on the 116M/116E is $75. The employee is paid every two weeks and the deduction will occur with each check (26 times a year).

Step two: $75 X 26 = $1,950.

Step three: $1,950 ÷ 12 = $162.50 monthly premium reimbursement.

 

Example 3:

Policy holder is eligible for a reimbursement. This is a seasonal job, they are paid twice a month for 10 months.

Step one: The deduction amount is $90; the deduction will occur twice a month for 10 months (20 times a year).

Step two: $90 X 20 = $1,800.

Step three: $1,800 ÷ 12 = $150 monthly premium reimbursement.