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Health Insurance Premium Payment (HIPP) Program - On Exchange

Overview

HIPP Programs pay your monthly health insurance premiums up to $2,996 and certain outpatient medical out-of-pocket (MOOP) costs.

How to Renew Your Health Plan

You must renew your health plan through Covered California, and then submit the required documentation to your local Medication Assistance Program Enrollment Worker, or directly to the CDPH Medication Assistance Program within two business days. The fastest way to renew your health plan is to log in to your Covered California account.

There are two ways to renew your health plan:

Passive Renewal – You previously gave Covered California consent to access electronic data sources to obtain your application information; therefore, no action is required unless you want to change your health plan. CDPH advises you to contact Covered California during each open enrollment period to confirm that no additional action is needed on your part.
Active Renewal – You will update your household size and/or income, and if desired, change your health plan. If no action is taken, you will likely be renewed without the State Premium Assistance Subsidy and/or Advanced Premium Tax Credit (APTC), which may affect your HIPP Program eligibility.

You must renew your health plan using one of the following methods:

Log in to your Covered California account,
Call Covered California at (800) 300-1506, or
Work directly with a Covered California Enroller.

Choosing a Covered California Health Plan

During open enrollment, you may change plans. If you want to keep your doctor, you should call their office to see which health care plans they accept prior to changing your health plan.
The following links provide “report cards” for various Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. This information may assist in your health plan selection process:

HIPP Program Renewal

The fastest way to renew your HIPP Program is to work directly with your local Medication Assistance Program Enrollment Worker. Clients who are enrolled in a health plan through Covered California and want to maintain enrollment into the HIPP Program must submit:

Medication Assistance Program Client Attestation Form (CDPH8723) (PDF) (with all applicable boxes checked)
Current health insurance plan billing statement(s) (for medical, dental, and/or vision-combination plans as applicable)
Covered California “Current Enrollment” or "Confirmation Enrollment" page with the following information:

your name (names of those covered by the plan)
premium amount
name of the health plan
APTC amount
plan effective/start date
enrollment confirmation number (if available)
health plan billing address (if available)
If you are enrolling in a dental and/or vision plan, be sure the documents include information for those plans as well.

Medication Assistance Program Fax Coversheet (CDPH 8730) (PDF), if faxing

Within two business days of renewing your health plan through Covered California, you must submit your health plan documents to your local Medication Assistance Program Enrollment Worker, or directly to the CDPH Medication Assistance Program.

Please note: Clients who enroll in a health plan through Covered California must submit documents to the CDPH Medication Assistance Program by November 30, 2024 for a January 1, 2025 start date. If you submit documents to CDPH after this date, it is recommended you make the initial premium payment to secure your health insurance. Otherwise, you may not receive a January 1, 2025 effective date.

How to Submit Documents

Work with your local Medication Assistance Program Enrollment Worker to submit documents electronically (this is the fastest and preferred method), or

Email, fax, or mail the documents to CDPH:

Email: CDPH MedAssistFax@cdph.ca.gov
Fax: (844) 421-8008
Mail: CDPH – Insurance Assistance
P.O. Box 997426, MS 7704
Sacramento, CA 95899

Open Enrollment Dates for Covered California

Open enrollment for Covered California is November 1, 2024 through January 31, 2025.

Tax Credit/Premium Subsidy

You may qualify for an APTC to help pay for your insurance premium.

If you qualify for APTC, you must accept the full amount to qualify for the HIPP Program.

Clients who received an APTC must file a federal tax return to determine if the APTC amount on their tax return is less than or more than their APTC. The client will either have a balance due or receive a refund. If an ADAP client has a liability to be paid (received too much APTC) or is owed a refund (did not receive enough APTC), requests to resolve over or under payments may be submitted directly to Pool Administrators Inc. (PAI).

APTC Refund – This means that HIPP overpaid the monthly premiums, therefore the APTC refund (for the applicable months) must be returned to HIPP.
APTC Tax Liability – This means that HIPP underpaid in premiums because your actual income was higher than the income you reported to Covered California and you received too much financial assistance. Therefore, HIPP will send a payment to the Internal Revenue Service (IRS) to cover the tax liability (for the applicable months) on the client's behalf upon receipt of the tax documentation and identification of the tax liability.
Clients must provide the documentation listed below to PAI. Taxes filed electronically must also include the electronic signature page.

Form 8962 (Premium Tax Credit)
Form 1095 A (Health Insurance Marketplace statement provided to the client by Covered California)
IRS tax return including the client's social security number (SSN) and the joint filer's SSN.

These documents may be submitted to PAI via the following methods:

Fax: (860) 986-6205
Email: PAI_CDPH@pooladmin.com
Mail: Pool Administrators Inc., ATTN: CDPH
628 Hebron Avenue, Suite 502
Glastonbury, CT 06033

Tax Penalty

Having health coverage is the law. If you don’t have it, you may have to pay a penalty to the California Franchise Tax Board. The penalty for not having coverage the entire year will be at least *$900 per adult, and $450 per dependent child under 18 in the household, when you file your 2024 state income tax return in 2025.

The penalty will be applied by the California Franchise Tax Board. For additional information or questions regarding this tax penalty, please visit the State of California State Franchise Tax Board and use their Penalty Estimator Tool, or contact your tax advisor.

Reporting Changes

Changes in your household size, income, or home address must be reported to Covered California within 30-days using the following methods:

Call Covered California at (800) 300-1506, or
Log in to your Covered California account

If these changes adjust your APTC, and/or premium, you must notify the HIPP Program immediately by submitting updated documentation to your Enrollment Worker and/or contacting the Medication Assistance Program Client Services call center.

Questions?

For questions about Medication Assistance Program eligibility and enrollment, please call:

Your local Medication Assistance Program Enrollment Worker, or
The Medication Assistance Program Client Services call center at (844) 421-7050. Client Services staff are available Monday–Friday, 8 A.M.–5 P.M. (excluding holidays).

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