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OFFICE OF AIDS

Employer Based Health Insurance Premium Payment (EB-HIPP)

EB-HIPP is a subsidy program that provides premium assistance for an ADAP client's portion of their employer based insurance premiums.  EB-HIPP pays the client's portion of their monthly medical and dental premiums, if eligible.  If a vision premium is included in the medical or dental premium, the client will have their vision premiums subsidized.

Eligibility Criteria

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

Be enrolled in an employer based insurance policy  

  • Have their employer sign an EB-HIPP Participation Agreement form

EB-HIPP Benefits

  • EB-HIPP premium maximum:  $1,938 per month in combined premiums
  • Combined premiums include the cost for medical, dental, and vision combination insurance plans
  • The clients portion of the insurance premium payments are sent directly to the employer on a monthly basis
  • EB-HIPP can cover medical and dental premiums. If a vision premium is included in the medical or dental premium, the client will have their vision subsidized. Standalone vision premiums are not eligible to be subsidized.
  • EB-HIPP pays for out-patient medical out-of-pocket (MOOP) costs that count towards the medical insurance plan's annual out-of-pocket maximum.

Note: EB-HIPP must pay the client's portion of their premium in order for the client to receive MOOP benefits

How to Apply

  1. Visit an ADAP enrollment site to enroll into EB-HIPP. The client will need to obtain a participation agreement form from an enrollment worker or from CDPH.
  2.  Return to the employer and complete the Participation Agreement form with their employer. The employer must sign and complete the Participation Agreement form in order for the client to be enrolled.

Note: If the employer does not agree to participate, the client cannot enroll into EB-HIPP

  1.  Submit the following supporting documentation to an ADAP enrollment worker or CDPH:
  • Completed Participation Agreement form;
  • Paystub dated within the last three months;
  • Completed and signed Client Attestation form
  1. Enroll in EB-HIPP
  • Once the required supporting documentation has been verified, CDPH will enroll the client into EB-HIPP.
  • Pool Administrator Inc. (PAI) will send payments to the employer.
  • The employer will be responsible for reimbursing the client's portion of their premium amount.

Maintaining Eligibility 

Re-Enrolling into EB-HIPP

Clients will be required to re-enroll into ADAP and EB-HIPP simultaneously in order to extend EB-HIPP eligibility.  Clients must re-enroll in the ADAP and the EB-HIPP program before their birthday month every year by submitting all of the required documents.  Documentation requirements for re-enrolling into EB-HIPP are as follows:

Note: if the client's premium or employer has changed, CDPH will need to review a new Participation Agreement form and paystub before a client's EB-HIPP eligibility is extended.

Recertification for EB-HIPP

Once a client is enrolled in the EB-HIPP program, they will be responsible for recertifying in ADAP and EB-HIPP six months after their birth month. Clients are required to recertify with our program by submitting a Self-Verification Form (SVF).  The SVF will provide instructions on how to recertify if the client's employer or premium has changed.

  • If the employer and insurance premium remains the same, the client does not need to provide supporting documentation for EB-HIPP (SVF will need to be submitted to extend ADAP eligibility)
  • If the client's insurance premium or employer has changed, the client will be required to resubmit the Participation Agreement form, Client Attestation form, and paystub dated within the last 3 months.

 

Reporting Employer or Premium Changes for EB-HIPP

If the client's insurance premium or employer has changed mid-year, the client will be required to resubmit the completed Participation Agreement form and paystub dated within the last 3 months.

Dental and Vision Plans

Dental plans can be covered only if a client is enrolled in EB-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.

EB-HIPP clients can remain on the program as long as the services are needed and they continue to meet all the program requirements.

For a full description of a client's responsibilities while enrolled in EB-HIPP please see our client checklist (PDF).

Questions?

Please contact the ADAP call center at (844) 421-7050.  Call center staff are available Monday-Friday, 8AM – 5PM (excluding holidays).

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