Benefits & Insurance

Medi-Cal Health Insurance Premium Payment (HIPP)

Table of Contents

• Medi-Cal HIPP Program
• Eligibility Requirements
• When Payment Is Made
• Application Process
• Where to Send Documents

Medi-Cal HIPP Program

Medi-Cal, California's Medicaid plan, operates a program called HIPP, which pays private insurance premiums for Medi-Cal beneficiaries.

This program is a cost-saving plan, since paying the insurance premiums for someone who is seriously ill costs much less than paying the medical bills which Medi-Cal would have to do in the absence of the insurance.

Eligibility Requirements

To be eligible for this plan the following requirements must be met:

1. There must be a private health insurance plan in force which covers the high cost medical condition. It may be an individual policy or a group health plan on self-pay through COBRA or a conversion policy. HIPP does not purchase new policies for persons. NOTE: HIPP will not pay the premiums for the California Major Risk Medical Insurance Plan (MRMIP).
2. There must be current Medi-Cal eligibility either with full Medi-Cal or with a Share of Cost less than $200. Share of Cost equals total income less health insurance premiums, child support, alimony and the Medi-Cal maintenance need of $600 ($620.00 for persons who are disabled). For example, someone who is disabled with an income of $950 and insurance premiums of $250 would be eligible for HIPP as their Share of Cost would be less than $200 ($950 - $250 - $620 = $80.00 Share of Cost).
3. The applicant must have a disability resulting in high medical costs, such as HIV/AIDS. Proof may be requested that medical bills exceed twice the monthly premiums, but this is usually waived with a diagnosis of AIDS.
4. The applicant must not be enrolled in a Medi-Cal related pre-paid health plan, the San Mateo County Health Plan, the Santa Barbara County Health Initiative or a Medicare HMO.
5. HIPP will NOT pay premiums for plans written by the California Major Risk Medical Insurance Plan (MRMIP).

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When Payment Is Made

Medi-Cal HIPP pays premiums on the twentieth of the month prior to the month of coverage. For example, October checks are cut and mailed on September 20. So applications must be submitted early in the month to have premiums paid for the following month. Current or back premiums cannot be paid by HIPP.

Application Process

To apply for the Medi-Cal HIPP program you should submit:

• A completed Health Insurance Premium Payment (HIPP) Referral Form (DHS 6172).
• Copy of a physician's statement of diagnosis, signed and dated.
• Proof of Medi-Cal eligibility (photo of Medi-Cal Card, Share of Cost form, etc.).
• Copy of the latest premium payment notice or a signed COBRA election form showing:
• Amount of premium
• Payee of premium payment
• Where the premium is to be sent
• Date premium is due
• Period premium covers (monthly, quarterly, etc.)
• Copy of insurance policy booklet (which describes benefits).

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Where To Send Documents

Documents should be sent to: Department of Health Services, HIPP Unit, HIPP Program, MS 4719, Box 997422, Sacramento, CA 95899-7422

For more information, call APLA at 213.201.1600 and ask to speak with a Benefits Counselor.

If you have questions about APLA, becoming a client or about any of the services we offer, call us at 213.201.1600 during normal business hours or send an e-mail. We are happy to help.

The Get Help section of this Web site includes:

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• Programs & Services
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