INCOME ALONE DOES NOT DETERMINE POOL ELIGIBILITY

To qualify for the LIPP you must:

• Be currently enrolled in the Pool or, if submitting an initial application, meet all eligibility requirements; and
   

• Certify that only you or someone in your family will be paying your monthly premium (no other third party may pay your premiums); and
   

• Meet the income guidelines; and
   

• Submit a LIPP Supplemental Application annually, along with required proof of household income.

To determine if you meet the income guidelines:

• Total the income of all related adult household members, as reported on the previous year’s Federal Income Tax Form (Line 4 of Form 1040EZ, Line 15 of Form 1040A or Line 22 of Form 1040)
   

• Total the number of related household members of all ages
   

• Find your household size and the corresponding income limits on the table below:

NOTE:  You must reapply and re-qualify for the LIPP annually no later than June 15^th for an effective date of July 1^st.