MEDI-CAL Health Insurance Premium Payment (HIPPP)


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:

  • 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).
  • 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).
  • 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.
  • 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.
  • HIPP will NOT pay premiums for plans written by the California  Major Risk Medical Insurance Plan (MRMIP)

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 doctor’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).

Where To Send Documents

Documents should be sent to:

Department of Health Services
HIPP Coordinator
Premium
Payment Unit
P.0. Box 1287
Sacramento, CA 95812-1287

Documents &  Forms:

Notice to Terminating Employees

Health Insurance Premium Payment Application

Health Insurance Questionnaire