VHAP and Catamount Health - Eligibility Worksheet          
2009 Poverty definition  
    Monthly Income      
Inputs   Wages Other            
Adult 1     Other income includes rents, dividends, etc.  
Adult 2   Change Y to N if no other adult. 0 if second adult has no income  
                   
Number of children      
Monthly spending on child care maximum of $175 per child    
              Premiums    
Eligibility Adults <per adult  
  Children   <per family  
                   
                   
Please note: Dr. Dynasaur premium is per family. If two figures are shown, the first is for children with other insurance  
  and the second is for children with NO other insurance.  
                   
  This sheet only tests financial eligibility. Programs have additional eligibility  
  requirements such as duration without insurance or reason for loss of previous coverage.  
                   
For additional information or to apply, call 1-800-250-8427 or visit http://www.greenmountaincare.org/  
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