Apply for GA HIPP now.Simply complete the application and:

The Georgia Health Insurance Premium Payment Program

helping Medicaid members pay for

employer-sponsoredhealth insurance—

at no cost to you!

Mail to:

Additional GA HIPP

application forms are

available at » County Division of Family and Children Services (DFCS) offices

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AIDS Advocacy Groups

GA HIPP Office

Do you have questions or need help filling out the GA HIPP application?

Give us a call at 1.678.564.1162. We’re open between 8 a.m. and 5 p.m. Monday-Friday, and are happy to assist you!

GA HIPP Unit900 Circle 75 Parkway,

Suite 650 Atlanta, GA 30339

Or fax it toll-free to: 1.800.817.1769

• Send proof of premium payment to theGA HIPP Unit each month (acceptableproof includes copies of pay stubs,bank statements, money order receipts,credit card statements, and letters fromemployers). GA HIPP will reimburse you foryour payment the following month.*

• Show your Medicaid and health insurance cards to yourhealthcare provider during your visit.

• Keep copies of Explanation of Benefits (EOBs) or paid claimsforms to support expenses related to medical conditions orongoing treament.

• Contact the GA HIPP office if your Medicaid eligibility, insurance coverage, or employment status changes.

* If you are receiving health insurance through COBRA or while on a leave of absence and the reimbursement methodis not possible, GA HIPP can pay premiums directly to your employer or insurance provider.

What are the benefits of participating in the GA HIPP Program?The GA HIPP program may provide:

• Medicaid payments for healthcare services notcovered by Medicaid

• Access to a larger network of providers

• Coverage for family members, including thosenot eligible for Medicaid

Step 1: Complete the application form and fax or mail it to the GA HIPP office.

Step 2: If you qualify, GA HIPP will begin reimbursing your monthly premium. If you are not already enrolled in your employer’s health insurance plan, you will need to enroll and begin paying the monthly premium to receive your reimbursements.

What is GA HIPP?The Georgia Health Insurance Premium Payment (GA HIPP) program may pay for your private, employer-sponsored health

insurance, if you or a family member receives Georgia Medicaid.

What happens after I am enrolled in GA HIPP?You’ll be asked to:

How do I apply for GA HIPP?It’s easy to apply for the GA HIPP Program:

How do I know if I qualify for GA HIPP?To qualify, you or a member of your family must:

» Currently receive Medicaid benefits

» Be eligible for employer-sponsored healthinsurance or a COBRA plan, if premiums arecost effective.