TX HHS Form 5020. Application for Texas Health Insurance Premium Payment (HIPP) Program

The TX HHS Form 5020, "Application for Texas Health Insurance Premium Payment (HIPP) Program", is a crucial document that helps individuals and families access affordable health insurance coverage. This form should be used by those who are eligible for Medicaid but can also get health insurance through their employer or another source.

The application requires key information about the individual, including their social security number, date of birth, and email address. Additionally, it asks about the health insurance or COBRA benefits they can obtain, such as the company name, policy start date, and monthly premium. The form also needs to know about the employer or other place offering the insurance, including their area code and phone number.

To complete the application, individuals must provide their Medicaid case number and list all family members who receive Medicaid benefits. The form also inquires about pregnancy status and due dates for any expectant mothers. Finally, applicants must submit the completed form along with supporting documents, such as an employer's Summary of Benefits and Rate Sheet, and a copy of their insurance card (if already insured). Forms can be faxed to 866-409-1188 or mailed to HIPP Program at P.O. Box 201120, Austin, TX 78720-9774.