健康保险费支付计划/成本规避
The Health Insurance Premium Payment (HIPP) program is a voluntary program for qualified members with full scope Medi-Cal coverage. HIPP approved Medi-Cal eligible members shall receive services that are unavailable from third party coverage and offered by Medi-Cal. Members with restricted Medi-Cal coverage are not eligible for the HIPP program.
HIPP 的要求：
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:
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:
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.
In any month that a HIPP enrollee has not met his/her monthly spend-down obligation, the enrollee will not be reimbursed.
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 enrolled in the following:
- 医疗保险
- TRI-CARE（原名 CHAMPUS）
- Medi-Cal 管理式医疗
如果您正在从 HIPP 计划过渡到 Medi-Cal 管理式医疗计划并需要帮助，请使用以下方法之一联系 HIPP 计划：
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
HIPP 工作人员将协助您与您选择的管理式医疗计划工作人员取得联系。
有关 Medi-Cal 管理式保健的更多信息，请访问Medi-Cal 管理式保健网页。