OFFICE OF AIDS NOW PAYS FIRST MONTH’S HEALTH INSURANCE PREMIUM PAYMENT

By Chuan Teng, Esq.

Managing Legal Director

CA Office of AIDS’s Health Insurance Premium Payment program (OA-HIPP) now pays the first month’s premium (“binder payment”) for eligible health insurance plans (Management Memo 2016-18). Individuals must enroll in OA-HIPP within 48 hours of enrolling in a health insurance plan to access the binder payment benefit via OA-HIPP.

Individuals who miss the 48 hour deadline for binder payment may be eligible for limited special funding through AIDS Emergency Fund. See below.

HEALTH INSURANCE PLANS ELIGIBLE FOR OA-HIPP BINDER PAYMENT

The following health insurance plans sold through Covered CA are eligible for OA-HIPP binder payment.

  • Blue Shield
  • Kaiser
  • Anthem Blue Cross (non-Covered CA plans also eligible)
  • Health Net

HOW TO ENROLL (FOR NEW OA-HIPP ENROLLMENT)

New clients must enroll in OA-HIPP with a certified ADAP/OA-HIPP enrollment worker within 48 hours of enrolling in an eligible health insurance plan to access binder payment.

NEW CLIENTS: Immediately after health insurance plan enrollment, submit to an enrollment worker a Covered California Enrollment History or Current Enrollment summary page which includes the following information:

      • Premium amount
      • Health plan name and medal tier
      • Advanced Premium Tax Credit taken
      • Health plan billing address (if available)

(*A screenshot or screen-print(s) from the Covered California account is permissible.)

ENROLLMENT WORKERS: Submit enrollment documentation through the A.J. Boggs portal by creating an Update Form using the People Picker tool and inform your ADAP Advisor of a new pending OA-HIPP application within 48 hours of the client’s health insurance enrollment.


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

    • STEP 1: Create an Update Form by using the People Picker tool to upload the enrollment documentation in the “most recent Covered California medical plan billing statement[2] field under the “Insurance Assistance” tab in the A.J. Boggs portal.
    • STEP 2: Enter the Covered California enrollment confirmation number located in the top left corner of all summaries into the “Member or Subscriber ID” field.
    • STEP 3: Promptly notify ADAP Advisor that a new OA-HIPP application has been submitted and requires initial payment so the application is prioritized for review/approval.
    • STEP 4 (Follow-Up Steps Required AFTER Enrollment): Upload client’s billing statement with the client’s health plan member ID/policy number to the A.J. Boggs portal by creating an Update Form. The client will receive a health plan billing statement from his/her health plan once initial payment is made by OA-HIPP.

If the client misses the 48-hour deadline to enroll in OA-HIPP for binder payment, the client will need to make the initial premium payment out-of-pocket to secure health insurance. See below for special funding.

LIMITED SPECIAL FUNDING FROM AIDS EMERGENCY FUND

Limited special funding through AIDS Emergency Fund is available for individuals who miss the 48-hour deadline to enroll in OA-HIPP to access a binder payment. HIV-positive San Francisco residents may be eligible for special funding. For more information, contact AIDS Emergency Fund (415-558-6999 x 228).


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

[2] A billing statement is not required at the initial OA-HIPP enrollment. However, a billing statement must be uploaded in the A.J. Boggs portal after the binder payment is made and the health plan issues a billing statement to the client. See Step 4.

ACA+HIV: A Frontline View

Earlier this month, San Francisco HIV frontline workers convened to discuss San Francisco’s HIV systems of care and the effect of the Affordable Care Act (ACA) on these systems.

Over 50 frontline workers from 19 different organizations joined the conversation. Participants included case managers, benefits counselors, social workers, peer advocates, and medical providers.

San Francisco HIV Frontline Workers

Andy Scheer presents on changes in the HIV Systems of Care

The meeting opened with welcomes from Dean Goodwin, HIV Health Services Administrator of the San Francisco Department of Public Health and Shannon Weber of Getting to Zero, a coalition of organizations whose goal is to get to zero new HIV infections, zero HIV deaths, and zero HIV stigma in San Francisco.

Following their remarks, Andy Scheer, a medical social worker at SF City Clinic, gave a presentation on the ACA and changes in San Francisco’s HIV systems of care. Andy’s comments addressed greater accessibility of health insurance through Medi-Cal expansion and Covered CA (the healthcare marketplace established by the ACA); the intersection between health insurance, public benefits, and taxes; the impact of same-sex marriage on access to government benefits; and changes at the local level, such as SFDPH’s shift away from a specialized care clinic model to an integrated treatment model.

Keeping up with all these changes is challenging, and in a quick survey of participating frontline workers, seven out of ten responded that the ACA makes them want to “hide under their desk.” However, attendees recognized the importance of HIV frontline workers being fully informed and having up-to-date information about systems of care to best serve San Francisco’s HIV positive community. Though it is difficult to keep up with and adapt to all of the changes in HIV systems of care, the continued hard work of frontline workers is worthwhile because the changes brought by the ACA will ultimately strengthen the healthcare system and make care more accessible. Continue reading