Health Insurance Premium Cost-Sharing Assistance (HIPCA)

Health Insurance Premium Cost-Sharing Assistance (HIPCA) offers financial assistance for qualifying individuals to help pay for insurance premiums, co-pays, coinsurance or laboratory bills.

Applications are evaluated and considered on a case-by-case basis in scope with Ryan White Standards of Care. 

• HIPCA Policy and Procedure Guidelines
• HIPCA Online Application

What Is Required to Apply for HIPCA?

• Bills must be $10.00 or more (there is no cap on the bill amount).
• Service(s) provided must be within one year of HIPCA application.
• Statement date must be within six weeks of submission.
• An itemized bill is required that shows service(s) provided are HIV related (may provide additional documentation if needed).

How to Apply for HIPCA

• A case manager or client must complete an application within the MIDAP Online system.
• The application must be filled out and submitted with all supporting documentation and will be reviewed by a committee within two weeks of receiving the application.
• Once the application has been reviewed by the committee, detailed notes will be added to the “Case Notes” section in CAREWare to document if the application has been approved, denied or incomplete. Clients may access notes within the MIDAP Online system.
• Payments for HIPCA are distributed on Mondays unless it’s a holiday, in which case they will be distributed the following business day.

Additional Information

Services Covered

• Common services covered are labs, vaccines, medical appointment with an infectious disease doctor, dental work and vision care.

Services Not Covered

• Direct cash payments or cash reimbursements to consumers, including but not limited to third party bill, invoice, statements, i.e. collection services.
• Mental health therapy does not cover beyond 12 visits per calendar year unless adequate documentation is provided.
• Funds may not be used to cover premiums for Medicare Part B plans.
• Funds may not be used to make out-of-pocket payments for inpatient hospitalization and/or emergency department care. 
• Dental services not covered:
  • Crowns for third molars. Excluded teeth numbers are 1, 16, 17 and 32. 
  • Root canals for third molars. Excluded teeth numbers are 1, 16, 17 and 32. 
  • Bridges:
    • For lower arch.
    • With four or more teeth involved.
    • Made of porcelain/ceramic structure.
  • Periodontal surgery other than gingivectomy and gingival flap surgery.
  • Braces.
  • Implants and implant services.
  • Implant crowns or dentures attaching to an implant.
  • Cosmetic dentistry including bleaching.
  • Temporary dentures.
  • 2D or 3D X-ray imaging.
  • Services covered under a hospital, surgical/medical or prescription drug program.
  • Treatment of temporomandibular joint (TMJ).