Get Hipp Ga

This guide provides a comprehensive overview of filling out the Georgia Health Insurance Premium Payment (HIPP) application online. Follow these steps to ensure you complete each section correctly and efficiently.

Follow the steps to successfully complete the HIPP GA application.

1. Click the ‘Get Form’ button to obtain the application form and open it in your preferred editor.
2. Enter your head of household details, including full name, referral source, address, city, state, and ZIP code. Ensure accuracy to avoid any delays.
3. Provide details about your health insurance policy. This includes the policyholder's name, insurance company name, policy number, insurance company address, group number, policyholder's Social Security number, telephone number, date of birth, and email address.
4. Input information regarding the employer offering the policy. Include the employer's name, address, telephone number, city, state, and ZIP code.
5. List all Medicaid eligible persons covered under the policy. Include their names, Social Security numbers, and birth dates, using a separate sheet if necessary.
6. Indicate whether any persons listed are pregnant. If yes, provide their names and expected delivery dates.
7. Specify if any persons listed have been diagnosed with a medical condition. Provide the names and conditions, using a separate sheet if needed.
8. If known, provide the amount of premiums for the policy and how frequently they are paid (weekly, bi-weekly, etc.).
9. Provide the total amount your employer contributes towards this policy, if known.
10. Check the services covered under the policy, including hospital, physician, dental, drug, home health, and long-term care.
11. Indicate the month of your employer’s open enrollment period, if known.
12. Provide information if COBRA benefits might be available from a former employer, indicating if you have received COBRA forms and related dates.
13. Grant permission for the application processor to contact your employer or insurance carrier to verify your information.
14. Indicate if the applicant or any dependent has been injured at work or in an accident in the past 12 months, providing necessary details if applicable.
15. The final step is to sign and date the application, ensuring it is done by the policyholder only. Once completed, you can save changes, download, print, or share the form as required.

Complete your HIPP GA application online today to ensure timely processing.