Get Tx Application For Texas Health Insurance Premium Payment (hipp) Program Form 5020 2017-2025
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How to fill out the TX Application for Texas Health Insurance Premium Payment (HIPP) Program Form 5020 online
This guide provides detailed instructions on completing the TX Application for Texas Health Insurance Premium Payment (HIPP) Program Form 5020 online. Follow these steps to ensure accurate submission and expedite the processing of your application.
Follow the steps to successfully complete the application online.
- Press the ‘Get Form’ button to access the application and open it in the form editor.
- Begin by providing information about the person in your family eligible for health insurance. Fill in their first name, last name, Medicaid ID number (if available), Social Security number, full address including city, ZIP code, state, date of birth, email address, and the best phone number to contact.
- Next, provide details about the health insurance or COBRA benefits available to the person mentioned in Step 1. Input the health insurance company name, its address, the policy ID number, group number, policy start date (only if you currently have insurance), monthly premium amount, and indicate whether it's COBRA insurance by selecting 'Yes' or 'No.'
- Now, enter the employer or company information that is offering the health insurance. This includes the name of the employer or company, their phone number, address, city, state, and ZIP code.
- Provide your family's Medicaid case number, which can be found on the Medicaid ID card. Then, list all family members who are covered by Medicaid. For each member, include their first name, last name, and Medicaid ID number. Indicate if any members are pregnant, and if so, provide their due dates.
- Finally, to submit your application, ensure that the completed form is sent along with your employer's Summary of Benefits and Rate Sheet. If you currently have insurance, include a copy of your insurance card. For faster service, fax all documents to 1-866-409-1188, or mail them to the HIPP Program at P.O. Box 201120, Austin, TX 78720-9774.
Complete your TX Application for Texas Health Insurance Premium Payment (HIPP) Program Form 5020 online today to ensure prompt processing.
The Health Insurance Premium Payment (HIPP) program assists those eligible for Medicaid by covering their private health insurance premiums. In contrast, Medicaid provides health coverage to low-income individuals outright. Understanding this distinction helps you identify which coverage may best address your needs, and using the TX Application for Texas Health Insurance Premium Payment (HIPP) Program Form 5020 can simplify the process.
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