State of California Health and Human Services AgencyDepartment of Health Care ServicesHealth Insurance Premium Payment Application (See instructions for completing on reverse) Step 1: Tell us about.
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How to fill out the CA DHCS 6172 online
Filling out the California Department of Health Care Services (DHCS) 6172 form is an essential step for those applying for the Health Insurance Premium Payment (HIPP) Program. This guide provides clear instructions to help you complete the form efficiently and accurately online.
Follow the steps to complete your application successfully.
- Press the 'Get Form' button to access the CA DHCS 6172 form and open it in your selected editor.
- Begin by providing basic information about the applicant in the first section. Enter the full name of the applicant, their nine-digit Social Security Number, and a complete home address, including the city, state, and ZIP code. Be sure to include a daytime telephone number with the area code.
- In the next section, describe the health insurance policy. Here, you will enter the name of the insurance carrier, the policy start date, and the premium billing address. Additionally, include the policy number, total monthly premium, and the total number of people covered under the policy.
- Proceed to the HIPP eligibility requirements. You will need to answer several questions regarding enrollment in Medi-Cal and Medicare, as well as whether the policyholder is court-ordered to provide insurance. Answer these questions honestly to determine the eligibility for the HIPP program.
- Finally, sign the form as the applicant or an authorized representative, and enter the date when you completed the form. Ensure all information is accurate before submission.
- Once you have filled out the form completely, you can save your changes, download, print, or share the form as necessary.
Start completing your CA DHCS 6172 form online today to ensure your eligibility for the HIPP program.
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Get answers to your most pressing questions about US Legal Forms API.
How much money can I make and still get Medi-Cal?
Eligibility for Medi-Cal, California's Medicaid program, is primarily determined by income, with households needing to earn less than 138% of the federal poverty level (FPL).
What is the income limit for Medi-Cal 2024 in California?
EWC 2024 Income Eligibility Guidelines Number of Persons in Family/HouseholdMonthly Gross Household IncomeAnnual Gross Household Income 1 $2,510 $30,120 2 $3,407 $40,880 3 $4,303 $51,640 4 $5,200 $62,4005 more rows • Mar 8, 2024
What is the meaning of DHCS Medi-Cal?
Medi-Cal is California's Medicaid program. This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources.
What is the maximum income to qualify for Medi-Cal in California?
Most single individuals will qualify for Medi-Cal if there income is under $1,676 per month. Most couples will qualify if their income is under $2,267 per month. If you have disabilities, your income can be slightly higher. You can qualify for Medi-Cal even if you have assets.
Who administers Medi-Cal in California?
It is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS).
Is DHCS the same as Medi-Cal?
Medi-Cal is California's version of the Federal Medicaid program. Medi-Cal offers no-cost and low-cost health coverage to eligible people who live in California. The Department of Health Care Services (DHCS) oversees the Medi-Cal program.
Can I get covered in California if I am over 65?
If you're eligible for or enrolled in premium-free Medicare Part A (hospital insurance), you can't apply for new coverage through Covered California. However, if you must pay for Medicare Part A, you may sign up for coverage through Covered California instead of Medicare Part A.
Is California Care the same as Medi-Cal?
What is the difference in coverage between Medi-Cal and Covered California? Medi-Cal is health coverage, just like the coverage offered through Covered California. Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family.
What is the official name of Medi-Cal?
The California Medical Assistance Program (Medi-Cal or MediCal) is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal ...
What if my income is too high for Medi-Cal?
If your income is too high for Medi-Cal, you may qualify to purchase health insurance through Covered California. Covered California offers “premium assistance.” It helps lower the cost of health care for individuals and families who enroll in a Covered California health plan and meet income rules.
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