Welcome to the State of California 

Office of AIDS

Office of AIDS Health Insurance Premium Payment (OA-HIPP) Program Forms & Application Requirements 

 

OA-HIPP is a program that pays monthly health, dental and vision insurance premiums for eligible clients and their family members.

Quick Links:

 

Eligibility

To be eligible for the OA-HIPP program, a client must:

1. Be enrolled in ADAP

2. Have an HIV/AIDS diagnosis

3. Be a California resident

4. Be at least 18 years old

5. Have a Modified Adjusted Gross Income (MAGI) that does not exceed 500% Federal Poverty Level based on household size (Effective June 24, 2015)

6. NOT be enrolled in Medicare or Full-Scope (Free) Medi-Cal or Medi-Cal Expansion

 

This program is not available to individuals whose insurance premiums are paid or partially paid for by their employer.

Dental plans can be covered only if a client is already enrolled in OA-HIPP for a health insurance plan. Vision insurance can also be paid but only if included as part of a combined health or dental plan.

OA-HIPP clients can remain on the program as long as the services are needed and they continue to meet all the program requirements. Once approved and enrolled in the program, each OA-HIPP client will be required to re-enroll annually during their birth month and re-certify six months later.

Prospective OA-HIPP clients should expect to pay their monthly insurance premiums until it has been confirmed that their application has been approved and payment has been submitted to the health plan. New, complete applications will be processed within six weeks of receipt.

For a full description of a client’s responsibilities while enrolled in OA-HIPP please see our client responsibilities form here: http://www.cdph.ca.gov/programs/aids/Documents/OAHIPPClientResponsibilitiesForm.pdf

 

Back to top

 

Required documents to enroll into OA-HIPP

  • IAS Fax Coversheet (PDF)- This coversheet must accompany all faxes and emailed applications sent to CDPH/IAS. Documents submitted without this coversheet will be discarded. (UPDATED: July 15, 2015)
  • A signed and dated OA-HIPP Program Application (CDPH 8522) (PDF) (UPDATED: January 2015)
  • A signed and dated IAS Consent Form (CDPH 8695) (PDF)(UPDATED: July 13, 2015)
  • The most recent insurance billing statement from the payee. Billing statement must include the following information: current premium rate (including Advanced Premium Tax Credit [APTC] if applicant is a Covered California member), client subscriber or billing ID, policyholder’s name and billing address, and where check payments should be mailed
  • Additional required documentation for the following clients:
    • Enrolled in a Covered California health plan: Covered California Welcome letter for the most recent enrollment period or printout of the Plan Enrollment Summary. Either document must clearly state the client’s eligible APTC. The billing statement must indicate that the client elected to take the full APTC. When applying for assistance with dental plan premiums, if the insurance carrier for dental coverage is different than that of the client’s medical coverage, a separate OA-HIPP application must be submitted along with the corresponding billing statement
    • Enrolled in a family plan: supporting documentation of relationship to the primary policyholder is required. If a spouse is covered: a marriage certificate or evidence of registered domestic partnership. If dependents are included: a birth certificate or adoption documentation

Back to top

 

How to Apply

Clients have two options:

  1. Clients can contact their ADAP enrollment worker for help enrolling. An enrollment worker can help clients with the application process and submit the completed application to Office of AIDS (OA) on their behalf. A list of ADAP enrollment worker sites can be found here (PDF)
  2. Enroll directly with OA. If clients cannot reach an enrollment site or would prefer to enroll directly with OA, they can access the application here(PDF) , or they can contact the OA-HIPP program at (844) 421-7050 or by email at ias@cdph.ca.gov. Clients will be referred to someone who can help them request an application packet and/or receive help completing the application over the phone

 

Clients and/or their enrollment workers need to submit completed forms with original signatures and documentation directly to OA by fax or email, directing the application to a specific analyst (PDF) using the IAS Fax Coversheet (PDF) :

(916) 440-5490 or ias@cdph.ca.gov

Or by mail:

Insurance Assistance Section

California Department of Public Health

PO Box 997426, MS 7704

Sacramento, CA95899-7426

Back to top

 

Maintaining Eligibility: Recertification and Reenrollment

Once a client is enrolled in our program they will be responsible for updating OA-HIPP with any changes to their insurance policy. A good rule of thumb is to update your OA-HIPP information any time you’re updating your ADAP information. Mirroring ADAP requirements, clients need to re-enroll in the OA-HIPP program before the clients birthday month every year by submitting a new application along with required documents (see above).

Six months after their birth month, clients are required to recertify with our program by submitting:

  • A newly completed and signed program application
  • The most recent insurance billing statement from the payee. Billing statement must include the following information: current premium rate (including Advanced Premium Tax Credit [APTC] if applicant is a Covered California member), client subscriber or billing ID, policyholder’s name and billing address, and where check payments should be mailed

For Covered California clients: If a client received OA-HIPP assistance in the previous tax year, they must submit their most recent signed and dated federal tax return as well as IRS form 8962 (or IRS form 4868 for a tax extension) on their first recertification or reenrollment after April 15th. For more information about this requirement please see the client letter attached to Management Memo 2015-07 (PDF) .

 

Back to top

 

Additional Resources

  • OA-HPP Analyst Roster (PDF)  - Analyst assignments and contact information organized by payee
  • Enroll in a Covered California plan – Please note:
    • If an individual earns 138 % to 200 % FPL (approx.  $16,243 - $23,340), they can select an Enhanced Silver Plan for the lowest possible out-of-pocket health care expenses including copays and deductibles
    • If an individual earns between 201% to 500% FPL (approx. $23,341- $58,850) they can select a Platinum plan for the lowest possible out-of-pocket health care expenses including copays and deductibles
  • Apply for the Medi-Cal expansion – individuals that earn less than 138% FPL should apply to Medi-Cal expansion using the Covered California portal or through their local Medi-Cal county office
    • Please note that individuals that qualify for Medi-Cal, may also qualify for cost avoidance through Medi-Cal HIPP. For more information about Medi-Cal HIPP, please visit their website 
  • APTC Reconciliation Guidance Tool (PDF) - This reference guide walks Covered California clients through the Advanced Premium Tax Credit reconciliation process and directs them on how to file taxes 
  • OA-HIPP Client Responsibilities (PDF) (UPDATED: February 24, 2015) - not required, but very helpful tool that outlines what OA-HIPP applicants need to do to maintain good standing in the OA-HIPP program
  • OA-HIPP Brochure (PDF) - An overview of the OA-HIPP program
  • Payee Data Record (STD 204) (PDF)  - If a client is requesting payment for an organization that OA has not issued payments for in the past, the client or their enrollment worker should ask the organization to fill this out
  • Partial Payment Agreement OA-HIPP Program - CDPH 8722 (PDF)- This form must be submitted by clients who have a monthly insurance premium that exceeds the OA-HIPP program threshold
  • Request for Assistance - CDPH 8542 (PDF)

 

Back to top

 

For More Assistance

You may call 1 (884) 421-7050 or email ias@cdph.ca.gov for additional assistance.

 

You may also be interested in:

Office of AIDS Home

 

 
 
Last modified on: 7/15/2015 8:56 AM