What is HIPP?
HIPP is the Texas Medicaid program that helps families pay for employer-sponsored health insurance premiums. It is for families with at least 1 person who gets Medicaid.
People enrolled in any Medicaid program, except for the Children's Health Insurance Program (CHIP) and STAR Health managed care program, are eligible to enroll in HIPP.
There are no age restrictions in the HIPP program. The family member who has Medicaid and the family member who can get employer-sponsored health insurance can be any age.
Who Can Get HIPP?
If you can answer “Yes” to these questions, you should apply for HIPP:
- Does anyone in your family get Medicaid?
- Can someone in your family get health insurance at work?
You might be able to get HIPP if it costs Medicaid less to cover you or your family under employer-sponsored health insurance than it costs to cover family members who have Medicaid.
Employer-sponsored health insurance is a group health plan you can get through your job. The family member who gets Medicaid must be able to get coverage on this plan.
What are the Benefits of Getting HIPP?
There are many benefits to getting HIPP if you or a family member qualify:
- Your family can choose from more doctors than with Medicaid alone.
- HIPP can pay your portion of the employer-sponsored health insurance premiums for the entire family.
- You won’t lose your Medicaid benefits.
How do I Know Who Pays?
- If you have Medicaid and go to a Medicaid doctor, you do not have to pay the deductible or co-pay.
- If you have Medicaid, but don’t go to a Medicaid doctor, you must pay the deductible and co-pay, if required.
- If you don’t have Medicaid, you must pay the deductible and co-pay, if required.
How Does HIPP Work?
Every insurance plan has a different premium cost and covers different things. To join HIPP, your employer-sponsored health insurance plan must pay at least 60 percent of the costs when you:
- Visit the doctor
- Buy medicine
- Get care outside the hospital
- Have lab tests or X-rays
- Are in the hospital
This information is covered in the summary of benefits available from your employer.
What Do I Need to do to Get HIPP?
HIPP will need the following information for your enrollment:
- Insurance rate sheet
- Insurance card
- Proof of payment (if enrolled)
Once your complete documentation is received, Texas Health and Human Services (HHS) will review your case to determine your eligibility for the Medicaid HIPP program.
When Can I Sign Up for Insurance at My Job?
If you don’t already have employer-sponsored health insurance, talk to your employer to find out if you can sign up. There are several ways you can do this.
Some jobs will only allow you to sign up for insurance at a certain time. This is called open enrollment. If that happens at your job, just contact HHS 1 month before open enrollment begins.
Qualifying Life Event
You may not have to wait for your company’s open enrollment. Employers also must let you make changes for what are called qualifying events. Under state law, eligibility for HIPP is considered a qualifying event. That means you can sign up any time.
COBRA (Consolidated Omnibus Budget Reconciliation Act) is a type of health insurance you can get if you leave a job where you had insurance. If you have COBRA coverage, send us your COBRA rates. We will look at the rates and let you know if you can join HIPP.
How do I Apply for HIPP?
To apply, you can either complete the application form or call 800-440-0493. You also will need to submit the following required items:
- Employer-sponsored health insurance plan’s rate sheet. Your employer can provide your insurance plan's rate sheet. A rate sheet is an informational document that shows the insurance premium amounts you pay each month.
- Proof of health insurance payment if you already are covered. The date on the proof of health insurance payment must be the same month of submission. For example, if you are submitting a proof of payment in January of 2017, the date on your proof of payment must be January of 2017.
You can use any of the following as proof of payment:
- A copy of your paystub that shows a portion of your pay was deducted to pay for health insurance
- A copy of the front and back of a deposited check that shows you paid for health insurance
- A bank statement that shows funds were withdrawn from your bank account to pay for health insurance
- A letter on company letterhead from your employer stating you paid for health insurance
- A letter on company letterhead from your insurance company stating you paid for health insurance
You can’t use the following as proof of payment:
- An insurance bill that doesn’t show funds have been paid for health insurance
- A copy of a money order
- A handwritten receipt
- Copy of insurance card, front and back (if already covered)
The application process is not complete without the required items. You cannot substitute anything else for the required items. You will also need to update the rate sheet every time you reapply for HIPP. Please visit the How to Reach HIPP page for fax and email information.
If your insurance rates change, let us know as soon as possible and send us a new rate sheet. Keeping your HIPP records up to date helps us send payments to you on time.
After we review your case, we will let you know if your family can get HIPP.
You can print HIPP forms by clicking the links below.
Form 5020, HIPP Application
Use this to apply to HIPP.
Form 5021, HIPP Consent
Use this if you want another person to be able to talk to us about your family’s case.
Form 5022, HIPP Direct Deposit
Use this if you want your premium reimbursement to go to your checking or savings account.
Form 5023, HIPP Missing Check/Stop Payment
Use this when reimbursement check was not received.
Form 5024, HIPP Address Change
Use this if your address has changed.
Form 5025, HIPP Authorization for Use and Release of Health Insurance Information
Use this when allowing HIPP to speak to your employer on your behalf.
Form 5026 HIPP Summary of Insurance Expenditure Request
This form is used to tell the HIPP program what the employer sponsored insurance paid for the Medicaid recipients in the past year.
Fax Cover Sheet
Use this when faxing anything to HIPP.
Once You Start Getting HIPP
Once your HIPP program case is approved for renewal each year, you will need to continue submitting a proof of health insurance payment each month.
In most cases, your employer will take the health insurance premium amount out of each paycheck. A proof of this payment must be submitted to HIPP, and HIPP will reimburse the employee’s portion of the health insurance premium amount.
Please see “How to Apply for HIPP” for information about what can and can’t be used as proof of payment.
It’s best to send HIPP your proof of payment the same month you pay your health insurance premium. However, you may submit your proof of payment within 3 months from the month of coverage. Proof of payment received after this will not be reimbursed.
HIPP determines the month of reimbursement based on the latest date on the proof of payment.
In most cases, HIPP processes reimbursements within 7 working days after receiving a valid proof of payment. Reimbursements are normally sent out on Tuesdays and Thursdays. HIPP can reimburse you by mailing a check or direct depositing the amount into a savings or checking account.
During HIPP enrollment or re-enrollment, it can take up to 30 working days from the time HIPP receives all required documentation to process your health insurance information.
If you have not received your reimbursement check within two weeks after the date HIPP mailed your check, please fill out and submit the Stop Payment Form to HIPP. A new check will be sent to you after the completed Stop Payment Form has been received and processed.
With direct deposit, HIPP deposits your health insurance premium payment straight into the checking or savings account you choose.
To set up a direct deposit, send HIPP the following:
- Completed direct deposit form
- Voided check