TX HHS Form 5026. HIPP Summary of Insurance Expenditure Request

The TX HHS Form 5026, "HIPP Summary of Insurance Expenditure Request," is a crucial document for families of Medicaid clients who need assistance paying for employer-sponsored health insurance. This form helps solve the problem of navigating the Health Insurance Premium Payment (HIPP) program, which aims to provide financial support for medical and prescription expenses.

This summary request form requires essential information about the member(s) listed below, including Subscriber ID, Member Name, Date of Birth, Amount Paid for Medical, and Amount Paid for Prescription. The form also asks for reference numbers, insurance agent details, and contact information. It is recommended to fax the completed form to 1-866-409-1188 (toll-free) or email it as a PDF or Tiff file to [email protected].

The HIPP program is administered by the Texas Health and Human Services Commission (HHSC), which manages the Medicaid program in the state of Texas. The HIPP Helpline, available Monday to Friday from 7 a.m. to 7 p.m., Central Time, can be reached at 1-800-440-0493 for any questions or concerns. For those who are speech or hearing impaired, Relay Texas (7-1-1) is also available.