Health Insurance Premium Payment (HIPP) Program

DHCS may elect to pay health insurance premiums on behalf of MC recipients. The objective of the Health Insurance Premium Payment (HIPP) program is to reduce MC expenditures by continuing to pay an individual’s health insurance coverage when the cost of the premium would be less than the cost of MC benefits (as determined by DHCS).

HIPP Qualifications

An individual qualifies for HIPP when all of the following requirements are met:

The individual is active on Fee-for-Service MC.
The individual is not Medicare eligible.
The individual is not enrolled in a MC Managed Care Plan.
The premiums are not the court ordered responsibility of the absent parent.
The applicant or family member has a high-cost medical condition.
The expected MC program savings are greater than the amount of the premium cost.
The client has health insurance coverage, COBRA continuation, a conversion policy in effect or available, or coverage available through another source.
- If the health insurance lapsed within the last 60 days, submit an HIPP Program application. If the case appears cost effective, DHCS will contact the insurance company and find out if it is possible to reobtain the insurance.
For COBRA applicants, there is enough time for the State to process the application and get the premium paid to meet insurance company deadlines.

A timely application is defined as follows:

When Coverage Is Under	And HIPP Application Is Made Within
COBRA continuation	30 days of the insurance termination date.
A conversion policy	20 days of the insurance termination date.

The policy must cover the individual’s high cost medical condition.
The policy was not issued through the California Major Risk Medical Insurance Board.
There is no enrollment in a Medi-Cal related pre-paid health plan, County Health Initiative or Geographic Managed Care Plan.
There is no retro or past due payments due on the policy.

Note: Eligibility for HIPP begins the month the application is received.

EW Action

The “HIPP Application Form - Fillable” form acts as a referral to the HIPP Program. Follow the online instructions to complete it. The online form can be completed by the applicant/recipient or the EW.

Completing the Online Application

The online HIPP application must include the following information:

Online Form Fields	What to Enter
MC BIC Number	Client’s CIN
Name (last, first middle)	Client’s Name
Address (street, apartment no.	Client’s complete address
City, State, Zip Code	Client’s complete address
Contact Telephone Number	10-digit telephone number
E-Mail Address	The online application submission process requires a valid e-mail address. If the EW is completing the application for the client, the EW’s e-mail address should be entered
Are you currently on Medicare?	Yes or No
Is This a COBRA policy?	Yes or No
If Yes, please enter the policy start and stop dates: Start Date End Date	Enter the start & end dates (mm/dd/yyyy) of the COBRA coverage
How are insurance premiums currently paid: Paid by policyholder directly to insurance carrier paid by policyholder through payroll deduction Other	Must select the appropriate method of payment If “Other” is selected, must provide explanation in free-form text box.
Insurance Company	Name of the OHC Insurance (e.g. Kaiser)
Insurance Company Telephone Number	Business telephone number for the OHC Insurance company
Policyholder Name	Name of person who holds the OHC coverage policy (e.g. if insurance provided by employer, name of the employee)
Policy holder Address	Policyholder’s complete address
City State, Zip Code
Policy Number	OHC policy number
Group Number	OHC group number
Current Premium Amount	Out of pocket costs for insurance
Number of individuals covered under this policy	total number of individuals who have coverage
File Upload	This section requires that the following documents be uploaded with the application: Explanation of Benefits- at least 1 year of medical and pharmaceutical services Insurance Rate Sheet Breakdown or Current Premium Statement payee Data record HIPP Forms (located on the main HIPP website) •DHCS 9114 (if applicable) •DHCS 9119 •DHCS 9120 •DHCS 9121

It is vital that all potential HIPP applications be sent immediately. Timing in making the first premium payment to the insurance carrier is critical to the carrier's obligation to accept coverage.

Although it may appear that a client qualifies for HIPP, DHCS may/may not approve the HIPP application.

DHCS Responsibility

DHCS (HIPP Program) will:

Process the HIPP Application.
Initiate premium payments to the insurance carrier, employer, or recipient, if approved. (The premium payment is paid beginning the month the HIPP application is received).
Update MEDS with appropriate OHC code.
Reevaluate the premium payment cases annually. The EW and the client will be notified of any changes.

HIPP Approved

EWs must delete the private health insurance premium in CalSAWS (allowing for a 10-day notice if the SOC will be increased) and check to make sure the OHC is already entered in CalSAWS and that MEDS is coded correctly.

Note: There are no California Department of Social Services Administrative Adjudications Division hearings on appeals for denial of enrollment to the HIPP Program as of January 1, 1996.

HIPP eligibility can be viewed on the [HIAR] screen in MEDS. If the MC recipient is enrolled in the HIPP, the “Source” field will indicate “HIPP.”

Client Disenrolls from OHC voluntarily

If the EW learns that the client has voluntarily disenrolled from OHC for which the State is paying the premium, notify DHCS immediately by calling 1-866-298-8443.

After disenrollment is verified, DHCS will notify the EW to discontinue the client from MC with a timely 10-day Notice of Action (NOA).

Upon notification, the EW must:

Discontinue the person responsible for withdrawing from the State-paid health plan,
Issue a timely discontinuance NOA, and
Treat the discontinued person as an ineligible member of the MFBU. MC benefits must continue for members of the family unit who are unable to enroll on their own behalf.