Montrose Parent Group

updated April 2009

Health Insurance Buy-In (HIBI)

The Health Insurance Buy-In program (HIBI) pays the health insurance premiums, deductibles, coinsurance, and/or copays for Medicaid clients who have a private (group, COBRA, or individual) health insurance plan, when it would be cost-effective for Medicaid to do so. This is a service in addition to the client’s regular Medicaid benefits.

The purpose of the HIBI program is to stretch taxpayer dollars, to get more benefit for the money. Sometimes, it can be cheaper for Medicaid to pay a client’s private health insurance costs (premium, deductible, coinsurance and/or copays, if any) than to pay all of the medical costs. This is what cost-effective means.

WHAT HIBI CAN DO

þ The HIBI program can pay premiums to an insurance company, employer, COBRA administrator, or directly to the client or the policyholder (parent, spouse, etc.).

þ Only the portion of the premium that covers Medicaid client(s) will be paid. This is the amount the policyholder (spouse or parent) would save if he or she did not pay for health insurance for the Medicaid client(s). This amount is obtained from the premium cost breakdown supplied by the employer, health plan, or insurance company. The full premium amount will be paid only if it is necessary to obtain health insurance coverage for Medicaid-eligible client(s).

þ Premiums and cost-sharing will be paid beginning with the date the Department of Health Care Policy and Financing receives the completed request for HIBI (all parts) (no back-payments, except in rare cases).

þ For pregnant women, premiums will be paid through the end of the month following the birth of the baby. For all other cases, premiums will be paid as long as the client is Medicaid-eligible and it remains cost-effective to do so.

þ If the client’s doctor, pharmacy, etc. is not a Medicaid provider, the HIBI program will help pay his/her health insurance deductibles, coinsurance, and/or copays, if it would still be cost-effective to do so.

WHAT HIBI CANNOT DO:

Ö HIBI staff will not shop for health insurance plans for the client. He/she must decide what health insurance plan meets his/her needs best.

Ö The HIBI program cannot pay health insurance premiums if the health insurance coverage is a court-ordered obligation for medical support.

WHAT THE CLIENT NEEDS TO DO

1. Provide a complete, properly signed, HIBI REQUEST PACKET:

a) MS-10 form - must be signed by the policyholder or client.

b) HIBI Request form - must be signed by the policyholder or client

c) Premium Rate Sheet showing all rates offered (e.g., single, single + family, etc.)

2. If Approved:

a) Provide instructions on how he/she wants his/her premiums to be paid.

b) Provide any other paperwork (documentation) requested by HIBI staff.

STATUTORY AUTHORITY

Federal: 42 U.S.C. 1396e

State: C.R.S. 25.5-4-210

Volume 8 – 10 C.C.R. 2502: 8.066

“MUST HAVES” TO COMPLETE HIBI REQUEST:

1. MS-10 FORM – Commodity #615-82-92-0106 (Rev 1/2004)

2. HIBI REQUEST FORM – Commodity #615-82-92-2041 (Rev 10/2005)

3. PREMIUM RATE SHEET (price sheet) from the employer showing the EMPLOYEE COSTS for ALL RATES OFFERED, if premium covers more than one person.

Remember – Forms must be signed by the client, policyholder, or authorized representative. A POA (power of attorney) or HIPAA-compliant authorization MUST be attached.