What is the Health Insurance Premium Payment (HIPP) Program?
The Health Insurance Premium Payment (HIPP) Program is a program developed to help individuals and families afford their employer insurance when at least one person in the family is enrolled in Medicaid. New Hampshire Medicaid members who are employed or have a family member who is employed may be eligible for health insurance premium assistance through the Medicaid program.
Who Can Get HIPP?
Medicaid members who cannot afford to pay the premiums, coinsurance or deductibles of their employer group health plan may be eligible for HIPP and participate in their employer based plan.
You might be able to get HIPP if you can answer "yes" to these questions:
- Does anyone in your family get Medicaid?
- Can someone in your family get health insurance at work?
What if I Say "Yes" to the two Questions?
The HIPP program is mandatory for NH Health Protection Program (NHHPP) members. Once it is determined that you have an opportunity to participate in HIPP and you are a NHHPP member, you will be sent a HIPP Application in the mail to complete, or you can print the application below. You may also request one by calling (603) 271-5218 or (800) 852-3345 ext. 5218.
If you are not a NHHPP member, but members of your family are Medicaid members, you can request an application by contacting DHHS at (603) 271-5218 or (800) 852-3345 ext. 5218, or by printing the application below. The application needs to be completed by the person in your family that has access to insurance through their job. When the application is complete you must either mail it back to the address on the application, or fax it to (603) 271-8113. The application must be returned within 30 days from the date on the letter that comes with the application.
The State begins to process your application to first see if the employer-sponsored plan coverage is cost effective.
What is cost effectiveness and why is it a requirement of the HIPP program?
An Employer-sponsored plan must be cost effective. This means that it's less costly for the Medicaid program to pay for the Employer-sponsored plan on the employee's behalf then to directly pay for medical services. The costs that are used for the cost effective measurement are average total annual Medicaid cost of a person like the applicant, which equates to the monthly Managed Care rate, premium and average deductible amounts, as well as administrative costs.
The State will let members know by letter if the employer plan is approved.
What if the Employer Plan is approved?
Once your application has been reviewed and it is determined that your plan is approved, you will receive another notice letting you know if you will be in your employer based insurance. If you are an NHHPP member, and you are not in your employer plan already, then you must sign up once you get the notice. Your employer will also get a notice that you have been approved for employer-based insurance. Bring your notice to your employer and they will let you sign up even if it is not open enrollment.
What if my Employer Plan is NOT approved?
You and/or your family members are still eligible for NH Medicaid. If you were not accepted into HIPP and you are an NHHPP member, then you will receive instructions on how to sign up for one of the two Managed Care Organizations (MCOs) . If you or your family members are a NH Medicaid member, not under NHHPP, then you will not need to do anything and will remain covered under the MCO you originally selected.
Who should an employer contact with questions?
If you are an employer and have questions about the Health Insurance Premium Payment program, please send your inquiries to the following email address: TPLUnit@dhhs.state.nh.us.
How will I get paid?
Premium payments deducted from your pay check are reimbursed to you that month, toward the end of the month. A check will be sent to the subscriber address.
Co-Pays and Deductibles may be your responsibility if you receive services from a non-Medicaid provider, but the provider is in your employer sponsored insurance network. If you do not know if your provider takes Medicaid, call them and ask. In order to be reimbursed you will need to fill out a form, which is provided at the link below, and show proof of the visit and the amount charged. You will receive a check to reimburse you for your co-pays and deductibles.
If services are received from a Medicaid provider, then you do not have to pay any co-pays or deductibles to the provider. Medicaid will directly pay the provider.
HIPP participants must continue to be Medicaid members and meet the cost saving rules to continue to be eligible for the HIPP Program.
Can I choose not to participate in HIPP?
If the employer health insurance is determined to be cost effective and you are an NHHPP member who is the employee, then participation in the HIPP Program is a condition of continued eligibility for Medicaid.
How Does HIPP Work?
HIPP is a program to reduce Medicaid costs for those who have access to employer insurance. The Medicaid member maintains the Medicaid card, but the employer insurance is used as the primary medical resource. When you visit your provider you must bring both your Medicaid card and your employer's health plan card.
When you are in HIPP, you don't lose your Medicaid benefits. HIPP pays your private health insurance costs.
- It pays the premiums for everyone who gets HIPP.
- Medicaid pays the co-pays and deductibles directly to Medicaid providers and reimburses you if you go to a non-Medicaid provider.
What HIPP pays for?
|HIPP pays the premiums||Medicaid pays the co-pays when services are given by a Medicaid doctor||Medicaid pays the deductibles when services are given by a Medicaid doctor|
|Family member who gets HIPP and Medicaid|
|Family member who gets HIPP, but doesn't get Medicaid|
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