What is HIPP?

The Health Insurance Premium Payment (HIPP) program is a state Medicaid program that reimburses eligible people for their share of an employer-sponsored health insurance premium payment. The program reimburses insurance premiums if it is more cost-effective than paying Medicaid expenditures. This may include coverage for the full family premium or partial family premium.

What is employer-sponsored insurance?

Employer-sponsored insurance is a group health plan you may get through your job. The family member who gets Medicaid must be enrolled, or be eligible to enroll, to get coverage on the group health plan.

What is a summary of benefits?

A summary of benefits is a document provided by your employer or insurance company that shows the amount the insurance company pays for medical services provided under the group health plan.

What is an explanation of benefits (EOB)?

An EOB is a document provided by the insurance company that shows the type of medical service, the date of service, the amount paid by the insurance company, and the amount paid by the individual receiving medical services.

If I enroll in HIPP, can I still get Medicaid?

Yes. In HIPP, family members with and without Medicaid can use their employer-sponsored health insurance for services covered under their employer's group health plan, and family members with Medicaid can get Medicaid services that are not covered by the employer's group health plan.

Are individuals enrolled in any Medicaid program eligible to enroll in HIPP?

Individuals 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.

What are premiums?

Premiums are the amount an employee has to pay for employer-sponsored health insurance. For most group health plans, a premium is a monthly payment based on the number of family members enrolled in the employer-sponsored health insurance and the employer's group health plan rates.

What are co-payments or co-pays?

Co-pays are the amount your group health plan requires you to pay when you go to the doctor, hospital, or get tests done.

What are deductibles?

A deductible is the amount your group health plan requires you to pay for health services before insurance starts to pay. Once you have paid the total deductible amount required for the plan year, then you only pay for any other costs you may be responsible for paying, for example, a co-payment (if required).

How old do you have to be to join HIPP?

Age doesn't matter. Your family member who has Medicaid can be any age as well as the family member who can get employer-sponsored insurance.

Who counts as a family member?

For HIPP, a family member means anyone the employer-sponsored health insurance plan will allow on your insurance. It is usually limited to the person who gets the insurance, their spouse and the children who depend on them.

What does "cost-effective" mean?

Cost-effective means that it costs the Medicaid program less money to pay for your employer-sponsored health insurance premium than it does to pay for your Medicaid services.

How much will it cost for me to be in HIPP?

It won't cost you anything if you are eligible to enroll in HIPP.

When will I find out if I can join HIPP?

HIPP will send you a letter once your complete documentation has been processed. In most cases, we will process your documentation in about 7 working days after we receive it. During enrollment or re-enrollment in HIPP, it can take up to 30 working days from the time HIPP receives all required documentation. See "How do I Apply for HIPP?" on the homepage for more information on the required documentation.

When do my reimbursements start?

Once you are determined eligible, your reimbursements will start the month we receive complete documentation. See "How do I Apply for HIPP?" on the homepage for more information.

How long does it take to get reimbursed for a premium payment?

In most cases, HIPP will process your reimbursement in less than 7 working days after we receive a copy of your proof of payment. Premium reimbursements are made by direct deposit or sent by check on Tuesdays and Thursdays. During enrollment or re-enrollment in HIPP, it can take up to 30 working days from the time HIPP receives all required documentation to process your health insurance information.

What if my address changes?

Once you have reported the address change to Medicaid and your information is updated, contact HIPP and let us know. Or send HIPP a completed address change form with proof of your address.

Proof of address can include a current:

  • Mortgage statement
  • Lease agreement
  • Rent receipt
  • Utility bill
  • Texas driver's license
  • Texas motor vehicle registration
  • School record showing attendance in a Texas school

What if my job or health insurance company changes?

If the person who has the insurance plan changes employers or insurance companies, call HIPP and let us know. We will need a copy of:

  • The list of all insurance plans and rate sheets
  • A copy of the front and back of your new insurance card

If the person who has insurance leaves a job and gets COBRA insurance, you still might get HIPP. Send us your COBRA rates. We will examine the rates and let you know if you can get HIPP.

I have a new baby. What do I need to do?

You will have a 30-day window to decide whether to add your baby to the employer-sponsored health insurance plan. Call HIPP to update your case.

How often do I have to re-enroll in HIPP?

You will re-enroll at the beginning of every plan year or sooner if there are insurance changes before yearly re-enrollment.

What is a group health plan?

A group health plan is an insurance plan (including a self-insured plan) of, or contributed to by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families. [In accordance with Title 26, Internal Revenue Code, §5000(b)(1)]