​Health Insurance Premium Payment (HIPP) Program

The Health Insurance Premium Payment (HIPP) Program is a program developed to help families, who have at least one person enrolled in Medical Assistance (MA), pay for private health insurance through an employer.

HIPP is administered by Pennsylvania's Department of Human Services (DHS). It was designed as a cost containment program in order to save taxpayers money by purchasing cost effective employment related health insurance available to a Medical Assistance recipient.

Eligibility

• Who is eligible for HIPP?
  Active Medical Assistance recipients who are eligible for medical insurance through employment are referred to HIPP.
  

• How is eligibility determined?
  A HIPP Operation Specialist (HOS) conducts a review of the medical insurance that is available through the employer. They will conduct a cost analysis based on the amount of the premium and the policy benefits that are offered. If the Medical Assistance costs for a client are greater than the cost of the employer insurance, the client is enrolled into the HIPP Program.
  

• Can I choose not to participate in HIPP?
  No. If the employer health insurance is determined to be cost effective, the client is required to participate in the HIPP Program as a condition of continued eligibility for Medical Assistance. The client maintains the ACCESS card, but the employer insurance is used as the primary medical resource.
  
  
• Does a Client maintain their Medical Assistance eligibility and their ACCESS Card?
  Yes. A client must remain active in Medical Assistance to be eligible for HIPP. They use their ACCESS card in the same manner as every other Fee-for-Service Client. HIPP clients are advised to use Medical Assistance providers to ensure that Medical Assistance is available to pay any policy deductibles or services not covered by the employer insurance.
  
  
• What if the client is currently enrolled in a Department Managed Care Program?
  When clients are enrolled in the HIPP Program, they are automatically disenrolled from Managed Care and entered into a Fee-For-Service program.
  
  

• Does the client have to be referred through the County Assistance Office?
  No. Although most HIPP referrals are received from the CAO, persons wishing to be considered for enrollment in the HIPP Program, or other agencies acting on their behalf, may do so by phoning the toll free number of their HIPP Regional Office.

Payment

• Is the client responsible to pay any co-pays or deductibles required by the employer insurance?
  No! The client remains on Medical Assistance and, therefore, cannot be billed for any MA covered service administered by a participating MA provider.
  
  
• How does HIPP pay for the employer insurance?
  When a case is determined to be cost effective, a HOS works with the employer and the client to enroll the client(s) in the employer insurance. HIPP premium payments are usually sent directly to the employer; however, payment can be made to the client when necessary.
  
  

• What about non-MA members in the household?
  Non-MA members are not considered when determining the cost effectiveness of the employer insurance. However, when non-MA persons are eligible for enrollment without increasing the premium amounts, they may enroll in coverage.

Employers

For more information pertaining to our program, please view our Employer Packet.

Health Insurance Premium Payment Regions