Health Insurance Premium Program
The Health Insurance Premium Payment (HIPP) Program is a program to help individuals and families afford employer insurance when at least one person in the family is enrolled in New Hampshire Medicaid.
NH Medicaid members who are employed or have a family member who is employed may be eligible for health insurance premium assistance through NH Medicaid.
To qualify, your employer-sponsored health insurance plan must be cost effective. This means that it is less costly for the NH Medicaid program to pay your portion of your employer-sponsored health insurance premium then to directly pay for medical services. DHHS will do the cost effective calculation based on the information in your application. The costs that are used for the cost effective measurement are the average total annual Medicaid cost of the applicant (which equates to the monthly Medicaid managed care rate, premium and average deductible amounts, as well as administrative costs).
To find out if you are eligible, fill out the HIPP Application.
Once approved for HIPP, you will still be a Medicaid member. However, you will no longer be enrolled in your Medicaid Health Plan (also known as your Managed Care Organization). Your Medicaid benefits will be processed through Medicaid Fee For Service.
In addition to your Medicaid benefits, HIPP pays:
- your portion of your employer-sponsored premiums for everyone who is approved for HIPP, and
- your co-pays and deductibles. Co-pays and deductibles are either paid directly to NH Medicaid providers or reimbursed to you if you go to an in-network provider of your employer-sponsored insurance but who is not enrolled in NH Medicaid.
Under HIPP, all co-pays and deductibles for Medicaid services are covered by NH Medicaid if the provider is in-network with your employer-sponsored insurance plan. If the provider is a NH Medicaid provider, your co-pays and deductibles are paid directly to the provider when the provider submits a claim to NH Medicaid. If the provider is not a NH Medicaid provider, but an in-network provider under your employer-sponsored insurance plan, NH Medicaid will reimburse you for the co-pay or deductible you pay.
To be reimbursed, you will need to fill out a Reimbursement Request Form and show proof of the visit and the amount charged. You will receive a check to reimburse you for your co-pays and deductibles. You will need to complete an Alternate W-9 Form the first time you submit a form. Please see the links for all forms and instructions.
Who Can Get HIPP?
NH Medicaid members who cannot afford to pay 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?
You can request an application by contacting DHHS at 603-271-5218 or 800-852-3345 ext. 5218, or by printing the NH HIPP Application. The individual in your family who has access to insurance through their job is required to complete the application. When the application is complete, mail it to the address on the application or fax it to 603-271-8113.
What is cost effectiveness and why is it a requirement of the HIPP?
An employer-sponsored plan must be cost effective. This means that it's less costly for the NH 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 NH Medicaid cost of the applicant, which equates to the monthly NH Medicaid managed care rate, premium and average deductible amounts, as well as administrative costs. DHHS will do the cost effective calculation based on the information from your application.
What if the Employer Plan is approved?
Once your application has been reviewed and it is determined that your employer plan is approved, you will receive a notice. If you are not currently in your employer plan, you must sign up once you get the notice. 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 and will receive your healthcare through Medicaid Care Management. If you are already enrolled in a managed care organization (MCO), then you do not need to do anything. If you are not enrolled, you will receive a notice requesting you to select one.
Who should an employer contact with questions?
If you are an employer and have questions about the Health Insurance Premium Payment (HIPP) Program, send your inquiries to DHHS.ThirdPartyLiabi@dhhs.nh.gov.
How will I get paid?
Premium payments deducted from your paycheck are reimbursed to you that month, toward the end of the month. A check will be sent to the subscriber at the subscriber address.
Co-Pays and Deductibles may be your responsibility if you receive services from a non-NH Medicaid enrolled provider, but the provider is in your employer sponsored insurance network. If you do not know if your provider accepts NH Medicaid, call the provider and ask. In order to be reimbursed, you will need to fill out a Reimbursement Request 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. You will need to complete an Alternate W-9 Form the first time you submit a form. Learn more in the HIPP Instructions for Reimbursement of Co-Pays and Deductible.
If services are received from a NH Medicaid provider, 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 NH 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?
Yes, HIPP is a voluntary program in which you are not required to participate.
What do I bring to the provider?
When you visit your provider, you must bring both your NH Medicaid card and your employer's health plan card.