Cost Avoidance/Health Insurance Premium Payment Program

The Health Insurance Premium Payment (HIPP) program defers medical costs from Medi-Cal by reimbursing certain Medi-Cal beneficiaries’ private or employer-related health insurance premiums when it is cost effective.

Each applicant must meet all of the program’s eligibility requirements; if approved, each case is periodically re-evaluated to determine ongoing HIPP program eligibility. Please note that HIPP is not an entitlement program; therefore, there are no appeal rights.

Requirements for HIPP:

• Full scope or fee-for-service Medi-Cal
• A medical condition
• Current health insurance coverage (or access to health coverage through an employer at the time of application) – policy must cover the health condition
• Health insurance coverage must not be court-ordered

You are not eligible for HIPP if you are eligible for or enrolled in any of the following:

• Medicare
• Healthy Families
• Medi-Cal managed care plan (through Kaiser, L.A. Care, Health Net, etc.)
• County organized health plans (CalOptima, CenCal Health, Partnership Health Plan of California, etc.)
• TRI-CARE (formerly known as CHAMPUS)
• Insurance issued through the California Managed Risk Medical Insurance Board (MRMIB), Managed Risk Medical Insurance Program (MRMIP), or post-MRMIP Graduate Plans