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Wisconsin BadgerCare Fact Sheet
Health Insurance Premium Payment (HIPP) Program
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Health Insurance Premium Payment (HIPP) Program
The Wisconsin Department of Health and Family Services (DHFS) administers the
Health Insurance Premium Payment (HIPP) Program. In some circumstances, the
DHFS will enroll a BadgerCare family in an employer sponsored family health plan
offered by the employer of a BadgerCare family member. This is called the
Health Insurance Premium Payment program or HIPP.
HIPP will pay the family’s monthly premium, coinsurance and deductibles
associated with the family health plan and any BadgerCare covered services not
covered by the family health plan through BadgerCare fee for service.
BadgerCare families are required to pay a small copayment for services
received as fee for service, unless the family member is:
- Under 18 years old,
- Receiving pregnancy related services, or
- Enrolled in a BadgerCare HMO.
BadgerCare families eligible for the HIPP program will be enrolled if all of
the following conditions are met:
- A BadgerCare family member is employed and the family member’s employer
offers an employer-sponsored family health plan. The health plan must be a
major medical plan that covers at least physician services.
- Family members are not currently covered by any employer-sponsored family health
plan.
- The employer pays between 40% and 80% of the cost of the
monthly premium for an employer-sponsored health plan.
- The cost of coverage for the family, which includes the
employee’s share of the premium, coinsurance, deductibles and BadgerCare
services not covered by the employer health plan is less than the cost of
BadgerCare HMO coverage for the family.
Applicant Responsibilities
When families apply for BadgerCare at their local county/tribal social or
human services agency, they will be sent an Employer Verification of Health
Insurance form that requests information regarding employer-sponsored health
insurance. It is the employed family member’s responsibility to take the form
to their employer and ask the employer to complete and sign the form.
The Employer Verification of Health Insurance form must be returned before
BadgerCare eligibility can be determined.
State process to determine HIPP eligibility
If the employer reports that the family does not have access to health
insurance, the family will begin the BadgerCare HMO enrollment process (if the
family is in a BadgerCare HMO service area), while receiving fee-for-service
coverage.
If the employer reports that the family has access to health insurance for
which the employer pays less then 80%, the DHFS will send a HIPP Employer
Verification of Health Insurance Coverage form to the employer(s). This form is
used to gather additional information about the type of employer-sponsored
health plan offered, the cost of the plan and employer’s share of the premium.
If the employer indicates that the family has access to health insurance the
BadgerCare family will be placed in BadgerCare fee-for-service coverage while
the HIPP process proceeds. The BadgerCare HMO process is put on hold until the
DHFS does the necessary research and follow-up to decide whether the BadgerCare
family should be enrolled in HIPP.
DHFS will determine if the family is eligible for the HIPP program as
follows:
- If family members were covered by the employer plan in the last six
months, or the employer plan is not a major medical plan, or the employer does
not pay between 40% and 80% of the cost of the monthly premiums, the family is
not eligible for the HIPP program. The family will then be enrolled in a BadgerCare HMO.
- If the family meets the preliminary criteria for the HIPP program, the
state will determine if it is cost-effective to pay the employer-sponsored
health insurance premium, deductibles and co-insurance.
- If the state determines that it is not cost-effective to pay the employer-sponsored
health insurance premium, the family is not eligible for the HIPP program and
the family will be enrolled in a BadgerCare HMO (if the family is in a
BadgerCare HMO service area).
- If the state determines that it is cost-effective to pay the employer-sponsored
health insurance, the family is eligible for the HIPP program, and is enrolled
in the employer-sponsored health insurance plan.
If Eligible for the HIPP Program
The state will inform the BadgerCare family that they are eligible for the
HIPP program and that the state will pay the employee’s share of the
employer-sponsored health insurance premium.
BadgerCare families will be enrolled in the employer-sponsored health
insurance plan as soon as possible. State law allows a HIPP eligible BadgerCare
family to be enrolled in employer-sponsored health insurance without waiting
until the next open enrollment period.
If the employer offers two or more cost-effective health insurance plans, the
family will be asked to choose the health insurance plan they prefer. State
staff will provide information to assist the family in choosing a health plan.
If a BadgerCare family is enrolled in an employer-sponsored health plan,
BadgerCare will pay for any BadgerCare covered services not covered under the
employer-sponsored health plan.
Note: BadgerCare families eligible for HIPP are required to enroll in
their employer-sponsored health insurance plans or they will lose BadgerCare
eligibility.
Paying the Employer-Sponsored Health Insurance Premium
The state will work with the employed family member and the employer to set
up the most convenient way to pay the employee’s share of the employer-sponsored
health insurance premium. The options are:
- The premium is paid by the employer after wage withholding from the
employee. The employee will send a copy of his/her check stub that shows the
health insurance premium deduction. After the state receives the check stub,
it mails a check to the employee for his/her share of the cost of the
employer-sponsored health insurance premium.
- The premium is paid directly by the employer without any wage withholding
from the employee. The state will mail a check to the employer for the
employee’s share of the employer-sponsored health insurance plan.
- The premium is paid directly to the insurance company by the state. The
state will mail a check to the insurance company for the employee’s share of
the employer-sponsored health insurance plan.
For more information:
Information provided in this document is general. For more detailed information
on BadgerCare or the Health Insurance Premium Payment Program, please contact
your local county/tribal social or human service agency.
The Department of Health and Family Services is an equal opportunity employer
and service provider. If you have a disability and need to access this
information in an alternate format, or need it translated to another language,
please contact 1-608-266-3356 (voice) or 1-608-266-2555 (TTY). All translation
services are free of charge.
For civil rights questions
call 1-608-266-9372 (voice) or 1-608-266-2555 (TTY).
PHC 10095 (05/05)
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