What is HIPP?
HIPP is a reimbursement program that is available to individuals covered by private insurance and Oregon Health Plan (Medicaid). HIPP helps policy holders pay the premiums for their third party insurance (TPL). Policyholders determined eligible for HIPP receive a reimbursement check each month as long as:
Why would the state pay someone’s insurance premiums?
In many cases, individuals receiving Oregon Medical Assistance (also known as Medicaid or OHP) are able to have other health insurance while covered by OHP. Examples of TPL include employer-sponsored insurance, COBRA or commercial insurance purchased by the policyholder. When an individual is covered by both, TPL is normally the primary payer and Medicaid is the secondary payer.
HIPP helps policyholders keep their private insurance so they can continue to see their existing providers. It also saves the state money because the TPL becomes the primary payer for their medical services.
Who can apply for HIPP?
Anyone can apply, however, payments are only sent to policyholders determined eligible for HIPP. Policyholder’s do not have to live in the same household as the Medicaid recipient, but they do have to provide private insurance for someone covered by OHP.
What types of polices are eligible for premium reimbursement?
The insurance must be a comprehensive major medical policy that includes hospital, physician, lab, x-ray and full pharmacy benefits. HIPP is not available for non-major medical policies such as dental, vision, cancer or accident only. Other insurance requirements are:
- The Medicaid eligible client cannot be receiving Medicare.
- The Medicaid eligible recipient cannot be covered by CHIP (Children’s Health Insurance Program) or CAWEM (Citizen Alien Waived Emergency Medical).
- The insurance cannot be court ordered.
- The policyholder cannot be receiving a federal tax credit for the insurance.
What is the criteria to qualify for HIPP?
After you submit your application it will be reviewed by a Premium Reimbursement Coordinator (PRC). The PRC will look at the cost of the insurance, the benefits provided by the insurance, the deductibles and coinsurance, and determine if it is cost-effective for the state to pay the premiums. In some cases, the PRC may also consider if someone has a serious medical condition. Cost effectiveness is based on what the state would normally expect to pay for services in comparison to the cost of the premiums. They also consider if the policy type is eligible for premium reimbursement. See “What types of policies are eligible” above.
How do I apply for HIPP?
A policyholder or authorized representative can apply for HIPP by clicking the “Apply for HIPP Now” button on this page. The applicant will need information about the policyholder and insurance policy to complete the form.
How do applicants know if they qualify?
When the application/form is received, the TPL is verified and the application is sent to a Premium Reimbursement Coordinator for review. If HIG needs more information they will contact the applicant by email or USPS mail. Mailings are date sensitive so applicants should respond timely. If the insurance is employer-sponsored the applicant may be asked to have the employer provide information also.
After the determination is completed, the policyholder is notified by mail. If approved, payments begin the month after the determination is made. Payments are in the form of a check, and sent directly to the policyholder of the insurance.
IMPORTANT: Submitters should allow up to 90 days for processing after all documentation has been received.
Who do I contact for questions?
HIPP questions can be emailed to reimbursements.hipp@odhsoha.oregon.gov.