Redetermination Process

HIP redetermination process

By law, all HIP members must have their eligibility renewed every 12 months. Beginning in November 2017, changes will begin to be implemented for individuals enrolled in HIP. One of the primary changes is related to how a HIP member’s annual renewal process is completed.  This annual process is used by the state to determine if members remain eligible for HIP for another year of coverage.

The redetermination period is also one of the periods when a HIP Basic member can move to HIP Plus.

The annual eligibility review process is summarized below and involves either one or two notices being sent to the member. In completing the process, HIP members fall into one of three categories.

  1. Members who do not need to take action. These are members who have recently confirmed their information with the state and who, therefore, can be automatically found eligible for another year of coverage. These members will not receive a communication asking for more information, as no information is needed. These members will receive notice of their new benefit period approximately 45 days prior to the end of their current HIP benefit period (for example, individuals with a HIP benefit period that ends on December 31 will be mailed a renewal notice on or around November 15). This notice also provides these members the amount of their HIP Plus POWER Account contribution. This begins the opportunity for HIP Basic members to transition to HIP Plus. Members beginning a new benefit year in January can expect to receive an invoice from their health plan in early January. Paying this invoice will guarantee provision of HIP Plus benefits. Starting a new benefit period is one of the opportunities for HIP Basic members to move to HIP Plus benefits.
     
  2. Members who need to take action if there are changes. HIP members who have not had their information confirmed with the state recently, but for whom information is available through electronic sources (information the state can use to determine eligibility) will receive a form indicating what information the state will use to determine their eligibility for the next benefit year. These members will receive this form approximately 45 days prior to the end of their current HIP benefit period. If the information is incorrect, the member will be instructed to return their form and provide the correct information so their eligibility can be determined.

    These members receive a notice of their new benefit period approximately 15 days prior to the end of their current HIP benefit period. This notice will also provide these members the amount of their HIP Plus POWER Account contribution. This begins the opportunity for HIP Basic members to transition to HIP Plus. Members beginning a new benefit year in January can expect to receive an invoice from their health plan in early January. Paying this invoice will guarantee HIP Plus benefits. Starting a new benefit period is one of the opportunities for HIP Basic members to move to HIP Plus benefits.
     
  3. Members who MUST take action. HIP members who have not recently confirmed their information with the state and/or who cannot have their eligibility confirmed through electronic sources will receive a form that will indicate it must be returned. These members will receive this form approximately 45 days prior to the end of their current HIP benefit period. This form must be returned by the due date on the form, and these members must verify their information even if the information preprinted on the form has not changed. Individuals who do not return this form will not be eligible for continued coverage and will not be eligible to reapply for six months after the end of their benefit period. The form will make clear that action is required to continue HIP eligibility.

    Members in this group who successfully complete their redetermination and are found eligible for HIP for another year will receive notice of their new benefit period approximately 15 days prior to the end of their current HIP benefit period. This notice also provides these members the amount of their HIP Plus POWER Account contribution. This begins the opportunity for HIP Basic members to transition to HIP Plus. Members beginning a new benefit year in January can expect to receive an invoice from their health plan in early January. Paying this invoice will guarantee provision of HIP Plus benefits. Starting a new benefit period is one of the opportunities for HIP Basic members to move to HIP Plus benefits.

Examples of these notices are contained within this document

HIP Plus enrollment for basic members

During the first 60 days of their new benefit period, all members that are currently in HIP Basic or HIP State Plan Basic will have the opportunity to begin making POWER account contributions to enroll in HIP Plus or HIP State Plan Plus. HIP Plus members receive enhanced benefits such as vision and dental coverage and do not face copayments unless using the ER for a non-emergency. HIP Basic members would continue to receive HIP Basic benefits and have copayments applied for services until they make their POWER account contribution for HIP Plus.

Changing plans:

Beginning in November 2017, individuals who want to select a different health plan (i.e., a different insurance company) for the next calendar year will be provided an opportunity to do so from November 1 through December 15. A postcard will be sent to active HIP members with instructions on how to change plans during this timeframe. Plan changes requested in the period from November 1 through December 15 will be effective as of January 1, 2018.

More information is available about the new health plan selection period by clicking here.