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Health Insurance Premium Payment (HIPP) Program / Cost Avoidance

 

The Health Insurance Premium Payment (HIPP) program is a voluntary program for qualified beneficiaries with full scope Medi-Cal coverage.  HIPP approved Medi-Cal eligible beneficiaries shall receive services that are unavailable from third party coverage and offered by Medi-Cal.  Beneficiaries with restricted Medi-Cal coverage or who are no longer covered under the same existing commercial health insurance plan they were on at the time they enrolled into Medi-Cal are not eligible for the HIPP program.

Requirements for HIPP:

Any existing, medically confirmed, medical condition determined by the Department of Health Care Services (DHCS) to be a cost-effective condition is deemed to meet the cost-effectiveness criteria for the HIPP program.  If this does not apply, then the following requirements will be used to determine cost-effectiveness:

  1. Enrollment in an existing 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 existing individual or group health insurance plan upon date of application.
  2. When determining cost-effectiveness of existing individual or group health insurance plans, DHCS shall consider the following information:
    • The cost of the insurance premium, coinsurance, deductible;
    • The average yearly anticipated Medi-Cal utilization for the confirmed medical condition;
    • The specific health-related circumstances of the persons covered under the insurance plan; and
    • Annual administrative expenditures.
  3. In any month that a HIPP enrollee has not met his/her monthly spend-down obligation, the enrollee will not be reimbursed.
  4. In order to meet the cost-effectiveness criteria, HIPP enrollees are required to be in fee-for-service (FFS) Medi-Cal.

 You are NOT eligible for HIPP if you are eligible for or enrolled in the following:

  • Medicare
  • TRI-CARE (formerly known as CHAMPUS)
  • Medi-Cal Managed Care

 

If you are transitioning from the HIPP program into a Medi-Cal Managed Care program and are in need of assistance, please contact the HIPP program using one of the methods below:

 

Email                  HIPP@dhcs.ca.gov

Fax                     916-440-5676

Address              Third Party Liability and Recovery Division

                           HIPP Program- MS 4719

                           P.O. Box 997425

                           Sacramento, CA 95899-7425

The HIPP staff will assist with putting you in contact with your selected Managed Care program staff.

 

Additional information about Medi-Cal Managed Care can be found using the link below:

Medi-Cal Managed Care

 

             

Quick Reference Links

HIPP Application Form - Fillable

HIPP Application and Forms (PDF)
Solicitud y Formas para el Programa HIPP

Frequently Asked Questions (FAQ)

HIPP State Plan Amendment (PDF)

 

 

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Last modified on: 10/10/2018 2:24 PM