Applying for HIPP

If you think you might qualify for HIPP or HIPP for Kids, you can apply online or by filling out a paper application. Whether you apply for HIPP online or use the paper form, you will need to complete the same steps listed in the checklist below:

HIPP Application Checklist

• Complete all parts of the HIPP application (online or paper form)
• Complete the Employer Insurance Verification (EIV) Form
• Submit insurance summary (verifying deductibles, co-pays and co-insurance amounts)
• Provide current paystubs
• Submit front and back images of insurance card(s) of the Medicaid eligible family member(s)

HIPP Online is the quickest and most secure way to apply for HIPP and HIPP for Kids! Learn more about HIPP Online, or visit HIPP Online to:

• Create your new HIPP Online account
• Fill out your online application
• Upload your supporting documents
• Receive your application confirmation via email

You can also fill out a paper application by downloading the HIPP/HIPP for Kids App/Renewal/EIV form below. Submit your completed paper form by email, fax, or mail (contacts listed below).

Sending Information to HIPP Once You Are Enrolled

Enrolled HIPP and HIPP for Kids members must turn in documents on an ongoing basis to stay eligible for the program. HIPP members can submit verifications electronically by creating an account with HIPP Online. HIPP Online is designed to give you more security and control of your information and will save you time. Use HIPP Online to:

• Securely upload your quarterly and annual paperwork
• Confirm your HIPP information has been received
• Receive reminders when your paperwork is due
• Update your information if your premiums increase

Enrolled HIPP and HIPP for Kids members can also continue sending their documents and verifications through email, fax, and mail to the contacts listed below. For fax, mail and email, please be sure to include the HIPP case name, case number and your telephone number.

Contact

• Email scanned documents to HIPPcustomerservice@dmas.virginia.gov
• Fax documents to (804) 452-5447
• Mail to:
  Department of Medical Assistance Services
  Attn: HIPP Unit
  600 East Broad Street, Suite 1300
  Richmond, Virginia 23219