Employer-Based Health Insurance Premium Payment (EB- HIPP) Program Frequently Asked Questions (FAQs) for potential EB-HIPP Clients
Program Overview Questions
1. What is EB-HIPP?
California Department of Public Health (CDPH), Center for Infectious Diseases (CID), Office of AIDS (OA) has created a program that pays an AIDS Drug Assistance Program (ADAP) client's portion of their employer-based insurance premiums who have elected to participate in the EB-HIPP program and meets the program requirements.
2. Who is eligible for EB-HIPP?
To be eligible for EB-HIPP clients must meet the following criteria:
- Be enrolled in ADAP.
- Enrolled in employer-based insurance.
- Client must be employed by the employer to participate in the EB- HIPP program (client cannot be on a spouse or domestic partners employer-based insurance).
- Employer agrees to participate in the EB-HIPP program.
- Completed participation agreement form is completed by client and employer.
- Employment verified with full months' worth of paystubs dated within the last 3 months.
- EB-HIPP must pay the client's portion of their premium for the client to receive medical out-of-pocket (MOOP) benefits.
3. What services are covered under EB-HIPP?
- EB-HIPP pays the client's portion of their employer-based insurance premiums.
- EB-HIPP will pay medical and dental premiums.
- If a vision premium is included in the medical or dental premium, the client will have their vision premium subsidized.
- EB-HIPP pays client's MOOP expenses for outpatient services.
4. Will my health information be shared with my employer?
No, your health information will not be disclosed.
5. What communication will occur between my employer and CDPH?
Client should be aware that Pool Administrators Inc. (PAI) is the contracted vendor for the State of California and may contact the client's employer to get updated premium and payment information.
The information will be considered confidential but may be exchanged with the employer as necessary to determine client's eligibility and for the purpose of administering the program.
6. Can my employer ask PAI for information about the EB-HIPP program, such as why I qualify for this program?
Yes, but PAI will only release information that pertains to your insurance, premium payments, or personal information that identifies you in our database (i.e., name, date of birth, Social Security Number). In addition, the EB-HIPP program is confidential and will not disclose program information to your employer to protect your confidentiality. Your employer should refrain from asking you why you qualify for the EB-HIPP State-administered program as a participant's qualifications for and enrollment in the program is confidential under California privacy laws.
7. What if my employer asks me questions about EB-HIPP?
Clients should refer to EB-HIPP as the State of California Insurance Assistance Program to minimize the possibility of their employer linking the program back to the ADAP.
Clients do not have to disclose their HIV diagnosis to their employer. Diagnosis and qualification reasons and enrollment into the program is confidential. Employers are legally required to refrain from asking client's qualification reasons.
Clients should direct their employer to contact the State of California's contracted vendor at 877-804-5524. Enrollment Workers are not permitted to speak with a client's employer regarding EB-HIPP. Clients should not give employers any direct contact with ADAP or CDPH as it could link the client to ADAP.
8. What supporting documentation do I need to enroll into EB-HIPP?
ADAP clients must submit the following documentation to their Enrollment Worker or CDPH:
- Client Attestation Form (CDPH 8723)
- Participation Agreement Form – Completed by client and employer.
- Employment paystubs – Full month of paystubs confirming premium amount, dated within the last 3 months. Clients who are paid bi-weekly (i.e., every other Friday) are required to submit two consecutive paystubs.
If the premium is not reflected on the paystubs, then a Benefit Enrollment Form, Benefit Statement, or Benefit Summary Letter (refer to question 12 for Benefit Enrollment Letter requirements) can be submitted.
For retirees, in lieu of paystubs, a benefit enrollment form, benefit statement, or benefit summary letter.
9. Where can I access the Participation Agreement Form?
You may contact your ADAP Enrollment Worker, an ADAP Advisor, or the ADAP Call-Center to obtain the Participation Agreement Form.
10. What happens if I no longer work at the company listed on the Participation Agreement Form?
You will be required to resubmit a new Participation Agreement Form completed by the client and the new employer, a new Client Attestation Form and a full month of paystubs dated within the last 3 months. The forms can be submitted to your Enrollment Worker or to CDPH.
11. What happens if the information on the Participation Agreement Form changes after it has been submitted (i.e., employer address, premium amounts, payment period)?
If the information on the Participation Agreement Form changes (i.e., employer, employer address, health plan, premium amounts, payment period) once the form has been submitted, please have your employer complete a new form and return it back to you. In addition, you will also need to complete a new Client Attestation Form and provide a full month of paystubs dated within the last three months. If the premium is not reflected on the paystubs, then a Benefit Enrollment Form, Benefit Statement, or Benefit Summary Letter (refer to question 12 for Benefit Enrollment Letter requirements) can be submitted. The new forms will then need to be submitted to your Enrollment Worker or to CDPH.
12. If I submit a Benefit Summary Letter, what information is required?
A Benefit Summary Letter must include the following:
- Must be on company letterhead or state the name of the company
- Must be signed by the employer (wet or approved digital signature)
- Must be no older than 45 days from the date received by ADAP
- Name of employer or company
- Name and title of person writing the letter
- Employer or company address
- Employer or company phone number
- Date of the letter
- Client's name
- Insurance plan start date or premium change effective date
- Medical and dental monthly premium amount client is responsible for.
13. What is the re-enrollment timeline for EB-HIPP?
Re-enrollment for EB-HIPP will align with your ADAP re-enrollment date which is your birthday. You can re-enroll up to 45 days prior to your re- enrollment date.
14. Will I need to re-submit all EB-HIPP supporting documentation at re- enrollment?
- If your insurance premium or employer has not changed, you will only need to submit the following documents:
- One paystub (must be dated within the last 3 months).
- Client Attestation Form.
- If your insurance premium or employer has changed, you will be required to submit the following documents:
- One months' worth of paystubs (must be within last 3 months) to confirm premium amounts. If the premium is not reflected on the paystubs, then a Benefit Enrollment Form, Benefit Statement, or Benefit Summary Letter (refer to question 12 for Benefit Summary Letter requirements) can be submitted.
- Client Attestation Form.
- Completed Participation Agreement Form.
15. If I have a question regarding EB-HIPP, who can I contact?
You may contact your ADAP Enrollment Worker, an ADAP Advisor, or the ADAP Call-Center for any EB-HIPP questions.
16. Once I am enrolled into the EB-HIPP Program, will my employer and I be notified?
PAI will send a letter to your employer notifying them of your enrollment into the EB-HIPP Program. In addition, your Enrollment Worker will receive an email notifying them of your enrollment into the EB-HIPP program. Your ADAP Enrollment Worker will be responsible for notifying you of your enrollment.
17. If my EB-HIPP application is denied, will I be notified?
Your ADAP Enrollment Worker will be notified if your EB-HIPP application is denied. The reason for the denial will also be provided in the notification. Please work with your ADAP Enrollment Worker for a resolution.
18. Will my employer be notified if I lapse and get dis-enrolled from the EB- HIPP Program?
Yes, PAI will send a notification to your employer regarding your dis- enrollment from the EB-HIPP Program.