Health Insurance Premium Payment Program/Cov Nqi Avoidance
Qhov kev pab cuam Them Nqi Pov Hwm Kho Mob (HIPP) yog ib qho kev pab cuam ua haujlwm pub dawb rau cov tswv cuab tsim nyog uas muaj kev pab them nqi Medi-Cal tag nrho. Cov tswv cuab uas tsim nyog tau txais Medi-Cal uas HIPP pom zoo yuav tau txais cov kev pabcuam uas tsis muaj los ntawm kev pov hwm sab nraud thiab muab los ntawm Medi-Cal. Cov tswv cuab uas muaj kev pab them nqi Medi-Cal tsawg tsis tsim nyog rau qhov kev pab cuam HIPP.
Kev xav tau rau HIPP:
Txhua yam mob uas twb muaj lawm, uas tau lees paub los ntawm kev kho mob, uas Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) txiav txim siab tias yog ib qho mob uas tsim nyog tau txais kev pab cuam raug suav hais tias ua tau raws li cov qauv tsim nyog tau txais kev pab cuam HIPP. Yog qhov no tsis siv tau, ces cov kev cai hauv qab no yuav raug siv los txiav txim siab txog kev siv nyiaj kom zoo:
Enrollment in an individual or group health insurance plan shall be considered cost-effective when the cost of paying premiums, coinsurance, deductibles, other cost-sharing obligations, and administrative costs, are projected to be less than the amount paid for an equivalent set of Medi-Cal services.
The confirmed medical condition must be covered under the individual or group health insurance plan upon date of application.
When determining cost-effectiveness of individual or group health insurance plans, DHCS shall consider the following information:
- Tus nqi ntawm cov nyiaj tuav pov hwm, nyiaj npib, txiav tawm;
- Qhov nruab nrab txhua xyoo uas xav tias yuav siv Medi-Cal rau cov mob uas tau lees paub lawm;
- Cov xwm txheej tshwj xeeb ntsig txog kev noj qab haus huv ntawm cov neeg tau txais kev pab raws li kev tuav pov hwm; thiab
- Cov kev siv nyiaj txiag txhua xyoo.
Nyob rau hauv txhua lub hlis uas tus neeg sau npe HIPP tsis tau ua raws li nws txoj cai them nqi txhua hli, tus neeg sau npe yuav tsis raug them rov qab.
Txhawm rau kom ua tau raws li cov txheej txheem them nqi zoo, HIPP cov neeg sau npe yuav tsum tau them tus nqi rau kev pabcuam (FFS) Medi-Cal.
Koj TSIS tsim nyog rau HIPP yog tias koj tau sau npe rau hauv cov hauv qab no:
- Medicare
- TRI-CARE (yav tas los hu ua CHAMPUS)
- Medi-Cal Managed Care
Yog tias koj tab tom hloov los ntawm HIPP qhov kev pab cuam mus rau Medi-Cal Managed Care program thiab xav tau kev pab, thov hu rau HIPP qhov kev pab cuam uas siv ib txoj hauv qab no:
Email: HIPP@dhcs.ca.gov
Fax: (916) 440-5676
Chaw Nyob:
Lub Chaw Haujlwm Saib Xyuas Kev Lav Phib Xaj thiab Kev Rov Qab Tau Nyiaj Ntawm Sab Nraud
HIPP Program- MS 4719
PO Thawv 997425
Sacramento, CA 95899-7425
Cov neeg ua hauj lwm HIPP yuav pab muab kev sib cuag nrog koj cov neeg ua haujlwm Managed Care program.
Cov ntaub ntawv ntxiv txog Medi-Cal Managed Care tuaj yeem pom ntawm nplooj ntawv web Medi-Cal Managed Care.