Adjusted Health Premiums Application (DOC)
For full-time employee whose household income is less than $45,000.
Employees with an annual household income below $45,000 may qualify for a subsidy on their health insurance. Eligible employees must complete the adjusted health insurance premiums application and submit it to Human Resources on an annual basis. The health subsidy form needs to be submitted by December 1, to be effective January 1, 2018.