Office of AIDS Health Insurance Premium Payment (OA-HIPP) Assistance
The Health Insurance Premium Payment program administered by the Office of AIDS (OA-HIPP) pays for health insurance premiums and certain out-patient medical out-of-pocket costs for eligible California residents co-enrolled in the AIDS Drug Assistance Program (ADAP).
Eligibility Criteria
To be eligible for the OA-HIPP program, a client must:
- Be enrolled in ADAP (see ADAP eligibility criteria)
- Be enrolled in comprehensive health care coverage
- Not be fully covered by Medi-Cal
OA-HIPP Benefits
- OA HIPP premium maximum: $1,938 per month in combined premiums
- Combined premiums include the cost for medical, dental, and vision-combo insurance plans
- Premium payments are sent directly to the health plan on a monthly basis
- OA-HIPP can cover medical insurance premiums, dental insurance premiums, and vision insurance combination plan premiums (vision plan: vision plan must be included in a medical or dental plan; OA-HIPP cannot pay for stand-alone vision policies)
- OA HIPP pays for out-patient medical out-of-pocket costs that count towards the medical insurance plan's annual out-of-pocket maximum
How to Apply
OA-HIPP applicants must be co-enrolled in ADAP. To learn more about ADAP, please visit the AIDS Drug Assistance Program (ADAP) page or contact an OA-HIPP Advisor.
Clients have two options:
1. Contact an ADAP enrollment worker. An enrollment worker can help clients with:
- Submitting the required supporting documentation to ADAP, and
- Indicating in the ADAP Enrollment System that the client would like health insurance premium assistance.
- To find an Enrollment Worker near you, access the ADAP Enrollment Site List
2. Self-enrollment:
- Complete the following sections of the ADAP Application (PDF):
- Section 1 (Profile), Section 6 (Insurance), Section 7 (Read and Sign)
- Pages 10 and 11 (ADAP Consent Form)
- Complete an ADAP Fax Submission Coversheet (PDF)
- Obtain all required supporting documents:
- For all plan types: Current billing statements (for medical, dental, and/or vision-combination insurance plans, as applicable)
- For Covered California Plans: a Welcome Letter or "Current Enrollment" summary from Covered California showing how much premium assistance/advanced premium tax credit (APTC) the client qualifies for
- For Family Plans: documentation to substantiate the relationship between the client and other individual(s) listed on the health insurance policy (e.g., marriage/RDP/birth certificate, jointly-filed taxes)
Submit all of the above signed and completed forms to OA using the following methods:
California Department of Public Health
Insurance Assistance Section
P.O. Box 997426, MS 7704
Sacramento, CA 95899-7426
If clients or enrollment workers are having difficulty accessing enrollment materials or need additional assistance, they should contact the ADAP call center (844) 421ā7050.
Prospective OA-HIPP clients should expect to pay their monthly insurance premiums until it has been confirmed that their application has been approved and payment has been submitted to the health plan. New, complete applications will be processed within six weeks of receipt.
For a full description of a client's responsibilities while enrolled in OA-HIPP, please see our client responsibilities form (PDF).
Maintaining Eligibility
Once a client is enrolled in the OA-HIPP program, they will be responsible for informing their enrollment worker or ADAP of any changes to their insurance policy. A good rule of thumb is to update the OA-HIPP information any time the client is updating their ADAP information. Mirroring ADAP requirements, clients need to re-enroll in the OA-HIPP program before their birthday month every year by submitting all of the required documents.
OA-HIPP clients can remain on the program as long as the services are needed and they continue to meet all the program requirements.
Re-enrollment: Due every year on the client's birthday in conjunction with ADAP re-enrollment. Required documentation includes:
- Confidential Fax Cover sheet, and
- The most recent insurance billing statement from the health insurance plan with the following information:
- current premium rate (including Advanced Premium Tax Credit if applicant is a Covered California member),
- client subscriber or billing ID,
- policyholder's name and billing address, and
- where payments should be mailed
Covered California Clients:
If a client received OA-HIPP assistance in the previous tax year, they must submit their most recent signed and dated federal tax return as well as IRS form 8962 and 1095 A (or IRS form 4868 for a tax extension) on their reenrollment after April 15th. For more information about this requirement, please contact the ADAP call center at (844) 421-7050. To find an ADAP enrollment site that is also a certified Covered
California site, please reference the ADAP & Certified Covered California Enrollment Site List.
For information related to Open Enrollment please visit:
www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_ADAP_Open_Enrollment.aspx
Dental and Vision Plans:
Dental plans can be covered only if a client is already enrolled in OA-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.
Medical Out-of-Pocket Benefit:
CDPH will also pay outpatient medical out-of-pocket costs that count towards the client's health insurance policy's annual out of pocket maximum for clients who are enrolled in the OA-HIPP and Employer-Based Insurance (EB-HIPP) program. All OA-HIPP and EB-HIPP eligible clients receive a client ID card to provide to medical providers when they receive services. Please see the Medical out-of-pocket Guide for Enrollment Workers or the Medical out-of-pocket Guide for Clients, for additional information on how to submit a medical out-of-pocket claim.
Spouses and dependents, who are enrolled in ADAP themselves and listed as a family member on the OA-HIPP or EB-HIPP client's health insurance plan, are also eligible for the medical out-of-pocket benefit. Spouses and/or dependents can enroll in the Spousal-Dependent medical out-of-pocket program by completing and submitting the Family Plan Consent form and the Acknowledgment of Policies and Responsibilities form.
For medical providers who would like to establish a direct payment method for medical out-of-pocket costs, please contact the PAI Customer Service Representative team Monday through Friday from 8:00 am to 5:00 p.m. at (877) 495-0990.
Eligibility Questions?
Please contact the ADAP call center at (844) 421-7050. Call center staff are available Monday ā Friday, 8AM ā 5PM (excluding holidays)
Clients and enrollment workers can also contact an OA-HIPP Advisor for additional assistance.
Open Enrollment
Please visit the Open Enrollment page (English) (Spanish) for more information related to open enrollment and ADAP's Insurance Assistance Programs.