Health Insurance Premium Payment Program

Employer Group Health Plan Overview

The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) required all states to enact a program to identify cases in which enrollment of a Medical Assistance/Medicaid (MA) recipient in a group health plan is cost effective. An individual's enrollment in a group health plan is considered cost effective if the expenditures in MA payments are likely to be greater than the cost of paying the premiums and cost sharing obligations under an employer group health plan for those services. Enrollment in a cost effective employer group health plan is a condition of MA eligibility, except for an individual who is unable to enroll on his/her behalf. The Bureau of Financial Operations within DPW was given the responsibility to implement this initiative, which is called the Health Insurance Premium Payment (HIPP) Program.

Pennsylvania's HIPP Program consists of five regional offices, covering areas similar to the Office of Income Maintenance, County Assistance Office (CAO) regions. Although the HIPP Program receives referrals from many agencies and departments, the primary source of referrals is from the CAOs. When the availability of employment related group health insurance is identified during the intake or re-determination process, the information is added to the employer screen on the Client Information System (CIS). "Yes" responses to the HIPP questions on CIS generate weekly letters/applications to the client. Applications/referrals are received in the HIPP Regional Office, where they are evaluated for cost effectiveness and eligibility in the HIPP Program. Those cases determined to be cost effective are negotiated with employers, insurance carriers, and/or recipients to enroll recipients in the employer group health insurance and begin premium payments.

Central Office

Program Manager, HIPP Program
P.O. Box 8195
Harrisburg, PA 17105-8195
1-800-644-7730

Questions and Answers about HIPP Program

Q: What is the Health Insurance Premium Payment Program (HIPP)?
A: The HIPP Program is a cost containment program administered by the Pennsylvania Department of Public Welfare. The purpose of HIPP is to save taxpayer dollars by purchasing cost effective employment-related medical insurance available to Medical Assistance clients.

Q: Who qualifies for HIPP?
A: Active Medical Assistance (MA) recipients who have access to medical insurance through employment are referred to HIPP. HIPP representatives conduct a cost analysis based on who is eligible for the employer insurance, the amount of the premium, and the policy benefits. If the anticipated MA costs of the clients are greater than the cost of the employer insurance, they are enrolled in the HIPP Program.

Q: Can the client choose not to participate in HIPP?
A: No. If the available 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.

Q: What if the client is currently enrolled in a Department Managed Care Program?
A: When clients are enrolled in the HIPP Program, they are automatically disenrolled from Managed Care.

Q: Does the Client maintain their Medical Assistance eligibility and their ACCESS Card?
A: Yes. A client must remain active in Medical Assistance (MA) 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 MA providers to ensure that MA is available to pay any policy deductibles or services not covered by the employer insurance.

Q: Is the client responsible to pay any co-pays or deductibles required by the employer insurance?
A: No. The client remains on Medical Assistance (MA) and, therefore, cannot be billed for any MA-covered service administered by a participating MA provider.

Q: How does HIPP pay for the employer insurance?
A: When a case is determined to be cost effective, HIPP representatives work 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.

Q: What about non-Medical Assistance (MA) members in the household?
A: 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 the coverage.

Q: Does the client have to be referred through the County Assistance Office (CAO)?
A: 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 Program Regional Office.

Health Insurance Premium Payment Regions

Chestnut Ridge Regional Office

Counties: Allegheny, Clarion, Clearfield, Elk, Forrest, Jefferson, Mercer, Venango

P.O. Box H
Torrance, PA 15779-0115
1-800-684-7730

Clarks Summit Regional Office

Counties: Berks, Bradford, Bucks, Carbon, Chester, Delaware, Lackawanna, Lehigh, McKean, Monroe, Montgomery, Northampton, Pike, Potter, Sullivan, Susquehanna, Tioga, Union, Wayne

Third Floor Administration Building
1451 Hillside Drive – Newton Hall
Clarks Summit, PA 18411
1-888-819-9206

Harrisburg Regional Office

Counties: Clinton, Columbia, Dauphin, Lancaster, Lebanon, Luzerne, Lycoming, Mifflin, Montour, Northumberland, Perry, Schuylkill, Snyder, Wyoming, York

P.O. Box 8195
Harrisburg, PA 17105-8195
1-800-644-7730

Torrance Regional Office

Counties: Adams, Armstrong, Bedford, Blair, Cambria, Centre, Cumberland, Fayette, Franklin, Fulton, Huntingdon, Indiana, Juniata, Somerset, Westmoreland

P.O. Box H
Torrance, PA 15779-0115
1-800-684-7730

Warren Regional Office

Counties: Beaver, Butler, Cameron, Crawford, Erie, Greene, Lawrence, Philadelphia, Warren, Washington

185 Hospital Drive
Warren, PA 16365
1-800-440-9391