Health Coverage Tax Credit Washington State Employment Security Gap Grant
Gap Grant - Service Provider Desk Aid
The HCTC Gap Grant assists eligible workers by paying 65 percent of their health insurance premium payments during the time between when the worker mails the Registration Form to IRS/HCTC and when the worker receives the first IRS/HCTC invoice. Typically this takes from 60 to 90 days. Two Requirements for Eligibility 1. Initial Requirements: To be eligible for the HCTC Gap Grant, a worker must meet one of the following IRS/HCTC eligibility requirements: Received an Entitlement Determination showing eligibility for TRA and currently claiming either regular unemployment benefits or TRA from Washington State; or Receiving a benefit under the Alternative Trade Adjustment Assistance (ATAA) program for workers age fifty (50) or older, or Age fifty-five (55) or older and receiving a pension benefit paid by the Pension Benefit Guaranty Corporation (PBGC); and 2. General Requirements: A worker must also be covered by “qualified” health insurance on the first day of the month for which the credit is claimed. Qualified health insurance plans in Washington State are: Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision; or Washington Basic Health, an unsubsidized plan only; or Non-group/individual health insurance that began at least 30 days before the last paid day of work from their Trade impacted firm; or A spouse’s insurance from work, if the employer contributes less than 50% of the total cost. This type of coverage is qualified for the Yearly HCTC claimed on a federal income tax return not the Monthly HCTC or the Gap Grant. Service Provider Actions 1. For general questions refer the worker to the IRS/HCTC toll free number 1(866) 628 4282. For Gap Payment questions the toll free number is 1(877) 438 4838. 2. Obtain a copy of the worker’s Entitlement Determination Form 57 showing eligibility for TRA. If worker has not received the Entitlement, have them complete and sign a Request for Determination (855). Fax the 855 to the TRA Unit at (360) 902 9790. 3. Inform workers about the HCTC (Handout for Workers) and give same application for either the *Monthly Advance or **Reimbursement Gap Payment.
*Monthly Advance Gap Payment pays 65% of the qualified health insurance payment as they become due. **Gap Payment Reimbursement pays the worker 65% of the qualified health insurance premium they have already made for the current month or for a prior month within the current calendar year.
4. Confirm that worker’s health insurance company is on the state vendor list by phoning (360)4383287. If not on the vendor list have worker provide an invoice from their health insurance plan showing company name and phone number. The counselor will contact the Budget/Financial Unit/TAA to ascertain where to fax health insurance documents. Upon receiving the completed W9 from the health insurance plan, the Budget/Financial Unit/TAA will fax it along with the Request for Vendor/Participant Registration to Vendor Unit. Completed W-9 forms are needed for inclusion
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to the state vendor list. A Monthly Advance GAP Payment request cannot be processed until or unless the health insurance company is on the vendor list.
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Occasionally, a health insurance provider chooses not to be placed on the state vendor list. In this case the worker will have to pay the provider directly and request reimbursement from the Gap Grant. 5. Review the application for Monthly Advance or Reimbursement Gap Payment with the worker to ensure all portions are complete and accompanying documents are attached as listed below. If a worker presents a health insurance premium that is due imminently it is advisable to have them self pay then request a reimbursement from the Gap Grant. If requesting reimbursement, please provide the participant’s SKIES ID and name to the Budget/Financial Unit/TAA to request the participant be placed on the state’s Vendor List. Monthly Advance GAP Payment Requirements Completed Monthly Advance or Reimbursement GAP Payment Application Original invoice/bill from health insurance provider Copy of COBRA election letter, or other verification of continuing coverage with first request only Money order or certified (cashier) check payable to Employment Security Department for 35% of the cost for health coverage plus costs for vision, dental, life insurance or other charges. The costs for vision, dental, life insurance and other charges will have to be paid in addition to the 35% if not included as part of a comprehensive insurance package. No personal checks or cash accepted. Send the completed application with accompanying documents to Budget/Financial Unit/TAA immediately so the health insurance provider can be paid on time. Use overnight mail to expedite payment if the insurance premium is due within a couple of days. Timeliness is important to ensure the worker’s health insurance coverage will not be canceled. The code for overnight mail is 1190 1700. Overnight mail must be addressed to the physical address: Employment Security Department Budget/Financial Unit/TAA Attn: Lori Wallace, 3rd Floor 605 Woodland Square Loop Lacey, WA 98503 GAP Payment Reimbursement Requirements Completed Monthly Advance or Reimbursement GAP Payment Application, one application for each month requested Copy of invoice/bill from health insurance provider for each month requesting a reimbursement Copy of COBRA election letter, or other verification of continuing coverage with first request only Copy front and back of canceled check, or other proof showing payment has been received by the health insurance provider The worker pays 100% of the health insurance premium. Costs for vision, dental, life insurance or other charges must be part of a comprehensive insurance plan for reimbursement. If not part of comprehensive coverage the costs for vision, dental, life insurance or other charges will be deducted from the total amount of the premium paid. Health insurance premium payments can only be reimbursed for the current calendar year. Qualified medical insurance premiums paid by a worker during the current calendar year may be retroactively reimbursed to the worker for 65% of the amount of the payments during the months the worker met the HCTC eligibility requirements. A worker who has paid premiums during the previous calendar year, for months they were HCTC qualified, would have to claim the credit on their federal income tax return.
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Gap Grant Assistance Limits The state HCTC Gap Grant may assist with up to three months of requests. Requests for an exception to the three month rule must be reviewed and approved by the HCTC State Gap Grant Administrator. For requests beyond three months the participant must provide a signed statement indicating when they applied for the federal IRS/HCTC program and providing a detailed explanation of why their IRS/HCTC Registration Form has not been processed. Attach the statement along with all other required documentation to the Monthly Advance or Reimbursement Gap Payment Application when sending to the Budget/Financial Unit/TAA. Because exception requests must be reviewed and approved by the HCTC Gap Grant Administrator before payment can be issued, it is important for the participant to know when the completed Registration Form was mailed back to IRS/HCTC. 6. HCTC Gap Grant participants must be enrolled in SKIES as an Eligible Applicant, affiliated to WIA NEG 10 HCTC. Complete the Program Validation. Print the WIA-NEG validation form and retain the form in the participant file. Enter case notes into SKIES regarding each of a participant’s requests for a Gap Payment. Budget/Financial Unit/TAA staff processing HCTC Gap applications will change the worker’s SKIES records from Eligible Applicant to Participant after the first Monthly Advance GAP Payment has been made to the health insurance company; or a Gap Payment Reimbursement is made to the worker. Exits from this program will be done by Budget/Financial Unit/TAA after the last payment is made. 7. If a participant file has been established, please create a separate section in the file for all copies of GAP Payment applications and supporting documents. If the worker has not been enrolled in TAA and therefore does not have a file, you must create a participant file. 8. Maintain the following documents in the file: Signed SKIES Registration form SKIES TAA Program Validation for WIA NEG HCTC and TAA Copies of picture ID and proof of eligibility to work in the US Selective Service Registration Verification – required for WIA Dislocated Worker or Adult Programs Entitlement Determination Copies of Gap Payment Application forms Complaint and Grievance/EEO participant information
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