1. (a) Participation in HIPP shall be voluntary and determined to be cost effective for the state medicaid program.
2. (b) Pending the determination of cost effectiveness, the medicaid recipient shall be eligible to receive medicaid covered services through the medicaid fee-for-service program, or through the managed care program.

3. (c) Premium assistance through the HIPP program shall not be available when:

   1. (1) The insurance plan is an indemnity plan that pays only a predetermined amount for covered services, such as dental or vision only plans, or long-term care plans;
   2. (2) The insurance plan is a school-based plan offered based on attendance or school enrollment;
   3. (3) The individual is only eligible for medicaid through in and out medical assistance in accordance with He-W 878.01;
   4. (4) The insurance plan is only offered for a temporary time period;
   5. (5) The eligible individual does not qualify for full medicaid benefits;
   6. (6) The insurance plan is through New Hampshire’s high-risk pool;
   7. (7) The insurance plan is a medicare supplemental policy, if the HIPP application was filed after March 1, 1996;
   8. (8) The insurance plan is COBRA;
   9. (9) The medicaid recipient is or becomes eligible for medicare;
   10. (10) No portion of the insurance plan premiums is paid for by the employer; or
   11. (11) The employer benefit package is a cafeteria plan and the employer does not contribute a percentage of the benefit package to the employer group health plan premium that the employee contributes.
4. (d) Premiums for dental plans shall not be covered by HIPP unless the employer plan premium does not separate the dental portion.

5. (e) The policyholder of the insurance plan shall provide information necessary to establish the cost effectiveness of the employer group health plan including but not limited to the following:

   1. (1) Health plan information, such as the plan name and policy number;
   2. (2) Premium liability, which is the portions of the premium that is paid by the policyholder and employer;
   3. (3) Co-insurance, which is the policyholder’s share of the cost of a covered health care services, and is generally calculated as a percentage of the total charge for the service;
   4. (4) Deductible, which is the amount the policyholder must pay for health care services before the employer group health plan begins to pay;
   5. (5) Co-pay liability, which is a fixed amount the policyholder pays for a health care service, and generally paid for at the time the services are rendered;
   6. (6) Covered benefits and services;
   7. (7) Any service limits applied to the benefit and service use by the health plan; and
   8. (8) Demographic information relative to other individuals on the policyholder’s plan, including name, gender, and age.

6. (f) In addition to the information listed in (e)(1)-(8) above, the policyholder shall also provide employer and employment information to the department to include:

   1. (1) The employer’s business name; and
   2. (2) Contact information for the employer's human resource department.
7. (g) A HIPP application shall not be processed until all information in (e) and (f) above are submitted.

8. (h) If the department or the department’s vendor determines that the employer group health plan is cost effective, the medicaid recipient shall:

   1. (1) Enroll in the health plan within 15 days of receiving notification from the department or the department’s vendor that the plan is cost effective, if not already enrolled; and
   2. (2) Upon enrollment, provide the department or the department’s vendor with confirmation of the start date of coverage.
9. (i) In the event that the mediciad recipient is already enrolled in cost effective group health plan prior to applying for HIPP, then the HIPP premium payments shall begin the month following HIPP approval notification.
10. (j) If the department or the department’s vendor determines that the group health plan is not cost effective, the medicaid recipient shall remain enrolled in their medicaid care management program or fee for service program in accordance with He-W 506.
11. (k) The department shall not pay premiums when the department determines the employer group health plan is not cost effective, even if the non-medicaid members are not able to change the employer group health plan.
12. (l) Enrollment in an employer group health plan shall not change the individual’s eligibility for medicaid benefits.

Source. #10632, eff 7-1-14; ss by #14075, eff 9-20-24, EXPIRES: 9-20-34