Health Insurance Premium Payment

 
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Medicaid & Long-Term Care
 
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No

What would you like to do?

What you need to know

​What is the Health Insurance Premium Payment (HIPP) Program?

The HIPP program pays for health insurance premiums of Medicaid-eligible individuals if it is cost-effective for the State. This is a cost savings measure for the State and does not affect Medicaid eligibility.

Who can quality for HIPP?

Medicaid-eligible individuals who have private health insurance or have the opportunity to enroll in private health insurance. The HIPP program determines whether it is cost-effective to enroll someone in the HIPP program.

The HIPP program will not provide premium assistance for:

  • Health insurance that is court-ordered;
  • Individuals eligible for Medicare, TriCare, CHAMPUS or CHAMPVA;
  • Premiums that are fully reimbursed by an employer, subsidy, or another third party;
  • Insurance that only provides catastrophic, limited benefit, limited duration or indemnity coverage; or
  • Medicaid clients only eligible for a Medically Needy Spend-Down or Share of Cost.

How is a health plan determined to be cost-effective?

The HIPP program will look at all cost sharing services and administrative costs. If the total is less than what it would cost for Medicaid to cover the equivalent set of services to the private health plan, then the policy is considered cost-effective.

The following documentation may be required with a HIPP application:

  • A copy of the insurance card (both sides);
  • Insurance Verification form;
  • Policy rate sheet provided by HR or business owner;
  • Complete Summary of Benefits from the insurance company; and
  • Paystub that includes premium deductions or if self-pay, billing statement from insurance company and proof of payment.

HIPP Reimbursements are made monthly

  • Premium reimbursements are issued to the policyholder electronically.
  • Proof of premium payment must be submitted to the HIPP program within 60 days of the paid date in order to receive reimbursement.
  • Premium reimbursements are processed the 15th of each month. If pay stubs are submitted after the 15th, then reimbursement may not be issued until the following month.
  • Proof of payment can include: Paystubs, cancelled check, bank statements, or credit card statements.
  • Premium reimbursements may be discontinued if the HIPP program requests documentation and it is not provided timely.

The following changes must be reported to the HIPP program within 10 business days:

  • Change of employment;
  • Loss of employment;
  • Change of insurance, coverage, or enrolled plan;
  • Change of insurance premiums;
  • Medicaid eligibility ends;
  • Death;
  • Move out of state; and
  • Any other change that would impact HIPP participation or reimbursements.

Forms:


 

 HIPP Program
Department of Health & Human Services
Phone Number

(402) 471-1648

(402) 471-8418