Missouri hipp program 2026

The document is an application form for the Health Insurance Premium Payment (HIPP) Program by the Missouri Department of Social Services. It collects information about the policyholder, their insurance details, and eligibility for MO HealthNet. The HIPP program aims to cover health insurance costs when it is more cost-effective than using MO HealthNet funds alone. Applicants must provide comprehensive details about their insurance policies and employment status to determine eligibility.

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Click ‘Get Form’ to open the Missouri HIPP Program application in the editor.
Begin by filling out Section 1 with the policyholder's information, including name, social security number, address, and telephone number.
In Section 2, provide details about your insurance, such as the insurance company name, claim mailing address, policy number, and group number. If no insurance is available, write 'no insurance available' across this section.
For Section 7, list all individuals who can be covered under the policy along with their birthdates and MO HealthNet eligibility status. Ensure to include social security numbers for each individual.
Complete questions regarding your current coverage status and employment situation in Sections 8 through 12. Be thorough in providing premium payment details in Sections 13 to 15.
Finally, sign and date the application at the bottom of the form before submitting it either by mail or to your Division of Family Services caseworker.

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