The Wisconsin Department of Health Services (DHS) administers the Health Insurance Premium Payment (HIPP) Program. In some circumstances, the DHS will enroll a BadgerCare Plus family in an employer sponsored family health plan offered by the employer of a BadgerCare Plus 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 Plus covered services not covered by the family health plan through BadgerCare Plus fee for service.
BadgerCare Plus 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 Plus HMO.
BadgerCare Plus families eligible for the HIPP program will be enrolled if all of the following conditions are met:
- A BadgerCare Plus 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 Plus services not covered by the employer health plan is less than the cost of BadgerCare Plus HMO coverage for the family.
When families apply for BadgerCare Plus at their local county/tribal 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 Plus 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 Plus HMO enrollment process (if the family is in a BadgerCare Plus 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 DHS 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 Plus family will be placed in BadgerCare Plus fee-for-service coverage while the HIPP process proceeds. The BadgerCare Plus HMO process is put on hold until the DHS does the necessary research and follow-up to decide whether the BadgerCare Plus family should be enrolled in HIPP.
DHS 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 Plus 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 Plus HMO (if the family is in a BadgerCare Plus 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 Plus 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 Plus families will be enrolled in the employer-sponsored health insurance plan as soon as possible. State law allows a HIPP eligible BadgerCare Plus 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 Plus family is enrolled in an employer-sponsored health plan, BadgerCare Plus will pay for any BadgerCare Plus covered services not covered under the employer-sponsored health plan.
Note: Enrollment in HIPP is voluntary. BadgerCare Plus families will not be denied BadgerCare Plus coverage, if they choose not to enroll in HIPP.
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 Plus or the Health Insurance Premium Payment Program:
- Visit the BadgerCare Plus web site at badgercareplus.org,
- Call Member Services at 1-800-362-3002 (TTY and translation services are fee of charge), or
- Contact your agency. To find the agency in your area, go to dhs.wi.gov/em/customerhelp or call Member Services at 1-800-362-3002.
The Department of Health 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 the agency.
For civil rights questions call 1-608-266-9372 (voice) or 1-888-701-1251 (TTY).