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Audio (MP3) Listen in New Window Presentation (PDF) Open in new window HIP Link Program Overview Healthy Indiana Plan (HIP) - HIP began January 2008 - Program for low income Hoosiers. - Modeled after consumer-driven healthcare. - Offers members a High Deductible Health Plan (HDHP) with a Personal Wellness and Responsibility (POWER) account to which members contribute. “HIP 2.0” Waiver – HIP Link - Indiana replaced traditional Medicaid and expanded HIP to all non-disabled Hoosiers ages 19-64 with household incomes at or below approximately 138%* of the federal poverty level. Hoosiers with incomes of up to $16,436.80 annually for an individual, $22,246.25 for a couple are generally eligible to participate in HIP. - *133% of FPL with a 5% income disregard. - HIP 2.0 includes HIP Link - a new premium assistance program for eligible individuals with access to employer-sponsored insurance. HIP 2.0 Approved - HIP 2.0 began February 2015. - HIP Link began in June 2015. What is HIP Link? HIP Link Basics HIP Link Overview HIP LINK: - Premium assistance program that helps employees pay for the cost of employer-sponsored health insurance - Option for employers, multi-employer plans, health plans and employees MEMBERS: - Like HIP, HIP Link members contribute 2% of their annual household income towards the costs of coverage STATE: - Provides $4,000 HIP Link Personal Wellness & Responsibility (POWER) Account to help cover a portion of the employee premiums and supplemental medical expenses HIP Link Income Guidelines Household Size Annual income limit for HIP Link eligibility Monthly income limit for HIP Link eligibility Maximum monthly 2% of income contribution 1 $16,436.80 $1,369.73 $27.39 2 $22,246.25 $1,853.85 $37.07 3 $28,055.69 $2,337.97 $46.75 4 $33,865.13 $2,822.09 $56.44 5 $39,674.57 $3,306.21 $66.12 6 $45,484.01 $3,790.33 $77.80 7 $51,293.45 $4,274.45 $85.48 8 $57,102.89 $4,758.57 $95.17 HIP Link Power Account HIP Link POWER Account Allocation Example HIP Link Enrolled Employee Annual Household Income $16,000 Member HIP Link 2 % Contribution $320 or $26.67 per month State Contribution $4,000 Total Available Funds $4,000+ $320 = $4,320 Employee Annual Premium $1200 Premium Reimbursement (Annual) $1200-$320 = $880 Premium Reimbursement (Monthly) $880/12= $73.33 $$ FOR COST SHARING $4,000-$880= $3,120 Employer Health Insurance Premiums Employers deduct employee premium by payroll deduction --> HIP Link POWER account funds used to send advance premium payment to employee prior to payroll deduction on a monthly basis Advance premium payment amount is reduced by 2% of employee household income Provider Payments for Out-of-Pocket Expenses Employee presents health insurance card and HIP Link card to provider or pharmacy --> Provider files claims with health insurance company providing the employer group coverage Insurance carrier pays its portion of the claim --> Provider files remaining claim balance with HIP Link Remaining expense will be covered by HIP Link POWER account up to $4,000 Who is eligible? HIP Link Premium Assistance Program Which employees are eligible for HIP Link? - Individuals must: - Be HIP eligible, - Have access to employer-sponsored insurance, - Be 19 years of age or older (less than 65), and - Have a household income under 138% FPL. - Coverage options: - May extend coverage to spouse or eligible dependent. - May compare HIP Link and HIP 2.0 coverage through the state during enrollment and elect one. Which employers and health plans are eligible for HIP Link? - Employers or Multi-Employer Plans must: - Contribute at least 50% to the premium cost, - Have a FEIN, and - Employ Indiana residents. - Health plans must: - Meet benefit requirements, - Essential Health Benefits and/or Federal Minimum Value requirements (including 9 EHB categories) - Mental Health Parity and Addiction Equity Act, and - Abortion requirements, in accordance with state and federal law. Why should Employers participate in HIP Link? Employer Participation Why should employers participate in HIP Link? - More employees may be able to enroll in the employer’s group health plan. - An increase in employees may help to meet industry and marketplace participation rates or lower group premium rates. - Potential to expand employee base and increase retention by being listed as an approved HIP Link Employer. - Possible tax benefits for small employers using the Health Insurance Marketplace. - HIP Link does not disrupt the current group health plan offered or cost sharing structure and can be incorporated at any time. - Employees can better manage healthcare costs with their HIP Link POWER Account and Health Reimbursement Account (HRA), if offered by employer. How does an Employer sign up? Employer Application Process Session I Register online at www.HIP.IN.gov --> Provide general business information and confirm: Employees reside in Indiana Business has FEIN Business contributes at least 50% to premium cost --> Receive confirmation email with information to complete Session II of the application Employer Application Process Session II Log into the HIP Link portal or continue after Session I to complete the remaining application --> Attest to benefit standards for each plan, Each plan must: Comply with A) state’s Essential Health Benefits (EHB) OR B) federal minimum value requirements and 9 EHBs categories, Comply with Mental Health Parity and Addiction Equity Act (MHPAEA), and Comply with abortion services in accordance with federal and state law --> Upload Health Plan Documents: Benefit summaries, Certificate of Coverages , etc. Employer and Employee Premium rates (medical, dental and vision if offered), and Health Reimbursement Account (HRA) amounts, if offered HIP Link Employer - Online application fully submitted - Health insurance plans approved for benefit requirements - Health insurance plans approved for affordability requirements - Employer receives active HIP Link Employer ID Ongoing Employer Requirements Verify Employees - When an eligible individual requests HIP Link, the HIP Link employer will be sent an email request to verify that the individual is employed and enrolled in or eligible for employer’s health insurance plans. - Employer will need to confirm the employee’s premium rate and dates of coverage. Monthly Employee Verifications - Confirm health insurance information on HIP Link enrolled employees is up to date and report changes in employment, if applicable. Annual Confirmation - Confirm enrolled existing or newly enrolled employee’s health coverage information is up-to-date, including any employment changes if applicable. - Provide updated health plan information for the next benefit period. How does an Employee sign up? Employee Enrollment 1. Becoming HIP Link eligible is considered a qualifying event and may be eligible for a special enrollment - 60 day special enrollment period begins when employer verifies employee is eligible for HIP Link 2. Enroll during employer’s open enrollment period Current HIP Members - Standard change reporting process, provide HIP Link Employer ID - Contact local Division of Family Resources (DFR) office - Call 1-800-403-0864 Non-HIP Members - Apply online with the Indiana Application for Health Coverage & select HIP Link - Contact local Division of Family Resources (DFR) office - CALL 1-877-GET-HIP-9 HIP Link Disenrollment Events - Change in medical status: - Become medically frail; or - Become pregnant. - Change in eligibility: - Employer is no longer compliant with HIP Link requirements; - Employer plan is unaffordable, does not meet benefit requirements, or is not offered; or - Employee is no longer eligible for HIP Link coverage due to loss of job, or loss of eligibility for employer-sponsored insurance. Resources To help individuals understand the HIP Link program, the State has developed additional resources available at www.HIP.IN.gov - Promotional letter to send to employers - HIP Link Employer Application Process, Checklist, Manual - PowerPoint presentation - One Page Program Summary - HIP Link Application Resource and Member Handbook - Full/detailed Frequently Asked Questions about program Questions? More information is available at HIP.IN.gov. Kayla Hsu, HIP Link Outreach Coordinator, Kayla.Hsu@FSSA.IN.gov Additional questions or comments may be sent to HIPLINK.ECT@fssa.in.gov or by contacting 1-800-457-4584. Employees may send inquiries to HIP2.0@fssa.in.gov or contact 1-877-GET-HIP-9.
Household Size
Annual income limit for HIP Link eligibility
Monthly income limit for HIP Link eligibility
Maximum monthly 2% of income contribution
1
$16,436.80
$1,369.73
$27.39
2
$22,246.25
$1,853.85
$37.07
3
$28,055.69
$2,337.97
$46.75
4
$33,865.13
$2,822.09
$56.44
5
$39,674.57
$3,306.21
$66.12
6
$45,484.01
$3,790.33
$77.80
7
$51,293.45
$4,274.45
$85.48
8
$57,102.89
$4,758.57
$95.17
HIP Link Enrolled Employee
Annual Household Income
$16,000
Member HIP Link 2 % Contribution
$320 or $26.67 per month
State Contribution
$4,000
Total Available Funds
$4,000+ $320 = $4,320
Employee Annual Premium
$1200
Premium Reimbursement (Annual)
$1200-$320 = $880
Premium Reimbursement (Monthly)
$880/12= $73.33
$$ FOR COST SHARING
$4,000-$880= $3,120
--> Receive confirmation email with information to complete Session II of the application Employer Application Process Session II Log into the HIP Link portal or continue after Session I to complete the remaining application --> Attest to benefit standards for each plan, Each plan must:
--> Upload Health Plan Documents:
HIP Link Employer - Online application fully submitted - Health insurance plans approved for benefit requirements - Health insurance plans approved for affordability requirements - Employer receives active HIP Link Employer ID Ongoing Employer Requirements Verify Employees - When an eligible individual requests HIP Link, the HIP Link employer will be sent an email request to verify that the individual is employed and enrolled in or eligible for employer’s health insurance plans. - Employer will need to confirm the employee’s premium rate and dates of coverage. Monthly Employee Verifications - Confirm health insurance information on HIP Link enrolled employees is up to date and report changes in employment, if applicable. Annual Confirmation - Confirm enrolled existing or newly enrolled employee’s health coverage information is up-to-date, including any employment changes if applicable. - Provide updated health plan information for the next benefit period. How does an Employee sign up? Employee Enrollment 1. Becoming HIP Link eligible is considered a qualifying event and may be eligible for a special enrollment - 60 day special enrollment period begins when employer verifies employee is eligible for HIP Link 2. Enroll during employer’s open enrollment period Current HIP Members - Standard change reporting process, provide HIP Link Employer ID - Contact local Division of Family Resources (DFR) office - Call 1-800-403-0864 Non-HIP Members - Apply online with the Indiana Application for Health Coverage & select HIP Link - Contact local Division of Family Resources (DFR) office - CALL 1-877-GET-HIP-9 HIP Link Disenrollment Events - Change in medical status: - Become medically frail; or - Become pregnant. - Change in eligibility: - Employer is no longer compliant with HIP Link requirements; - Employer plan is unaffordable, does not meet benefit requirements, or is not offered; or - Employee is no longer eligible for HIP Link coverage due to loss of job, or loss of eligibility for employer-sponsored insurance. Resources To help individuals understand the HIP Link program, the State has developed additional resources available at www.HIP.IN.gov - Promotional letter to send to employers - HIP Link Employer Application Process, Checklist, Manual - PowerPoint presentation - One Page Program Summary - HIP Link Application Resource and Member Handbook - Full/detailed Frequently Asked Questions about program Questions? More information is available at HIP.IN.gov. Kayla Hsu, HIP Link Outreach Coordinator, Kayla.Hsu@FSSA.IN.gov Additional questions or comments may be sent to HIPLINK.ECT@fssa.in.gov or by contacting 1-800-457-4584. Employees may send inquiries to HIP2.0@fssa.in.gov or contact 1-877-GET-HIP-9.