1. CIPA Connecticut Insurance Premium Assistance

2. CIPA Basics
CIPA is sponsored by the Connecticut Departments of Social Services in collaboration with the Connecticut Department of Public Health.
CIPA is funded through the federal Ryan White Part B AIDS Drug Assistance Program.

3. What is CIPA?
CIPA is a program that pays for health insurance premiums for people who are eligible or enrolled on CADAP (Connecticut AIDS Drug Assistance Program)
CIPA can pay up to $1,500 per month for approved health insurance premiums
CIPA pays the insurance company directly. CIPA will NOT reimburse the individual directly
If the insurance is sponsored through an
employer CIPA will pay the employer directly

4. How Do I Quality for CIPA?
Check list:
Connecticut Resident
A diagnosis of HIV or AIDS
Enrolled on CADAP
An income of 400% of the poverty level

6. Residency requirements
Individual income
Residency requirements
Apply for
Conditions
0-138% FPL
(about $16,642)
Citizen or
lawfully present resident for 5 years
Medicaid
Medicaid will provide coverage,
CADAP/CIPA services not needed
% FPL
(about $30,150)
lawfully present resident
Private Insurance
Silver Plans-are required for CIPA eligibility
Must select tax credit & cost sharing subsidy option through AHCT or the Marketplace
CADAP / CIPA insurance premium assistance
% FPL (about $48,240)
lawfully present resident
Platinum & Gold Plans are recommended or Silver Plans
 Must select tax credit & cost sharing subsidy option through AHCT or the Marketplace

7. What Kinds of Insurance Will CIPA Pay for?
CIPA will pay insurance premiums for your current insurance plan for a plan that you are applying for. CIPA will only pay for insurance plans that offer:
Drug coverage that is equal to or better than the current CADAP formulary which includes ART
Adequate hospital and medical benefits including physician/outpatient services, surgical, diagnostics, x-ray, lab and anesthesia services

8. What Insurance Plans will CIPA NOT Pay for?
Insurance plans that have certain coverage limits or caps on prescription refills and/or medical benefits
Family Plans
Dental insurance plan are not covered unless it is included in the medical insurance plan and cannot be “broken out”

9. Special Requirements Regarding Employer-Sponsored Health Insurance
CIPA applicants with employer-sponsored health insurance must authorize a CIPA representative to contact employers confidentially regarding the applicant’s employment, insurance coverage and premium payments.
Employers must agree to accept third-party payment.
If the applicant declines to authorize CIPA to contact his or her employer, the application will not be approved. If an employer does not agree to accept third-party payment, the individual’s CIPA application will also not be approved.

10. Prescription Drugs
Prescriptions must be filled through a pharmacy store or mail order pharmacy that is a Connecticut Medicaid provider
If your insurance company requires you to use a mail order pharmacy that is not a Connecticut Medicaid provider, CIPA will NOT be able to approve your application

11. Enrollment Applicant must be enrolled in CADAP
Applicant must have a CIPA-approved Insurance Policy
If the Applicant is enrolled in an insurance plan through the Access Health Exchange, CIPA will only accept Silver, Gold, or Platinum level coverage plans. Applicants with Bronze level coverage will be denied.

12. Complete application form that can be found on www.mycipa.com

13. Required Information Employer Provided (ESI) Private
Application /Renewal
Application/ Renewal
Insurance Card Front and back
Rx Card if Available
Summary of Benefits
Rate Sheet
Confirmation of Active Coverage
(usually letter sent when approved for the policy)
Pay stub (if deduction is not on Stub need letter from employer with Rate.)
Monthly Billing Statement
If there is a tax credit or subsidy need documentation with the amount.
Employer information
FEIN
Address
(A W2 can be used for employer information)
HR contact (name and number)
Open enrollment Dates
When Rates go in Effect

14. Application vs. Renewal
An application form is required if:
The applicant’s carrier has changed
The applicant’s employer has changed
The applicant is applying to CIPA for the first time
A renewal form is required if:
The insurance premium rate has changed but everything else remains the same

15. Monthly Documentation REQUIRED
Private Insurance: CIPA requires the monthly billing statement with the premium amount and coverage effective dates.
Employer Sponsored Insurance: It is required that the applicant submits 1 pay stub a month. If the deduction is not shown on the stub then there needs to be a letter from the employer stating the monthly deduction on file.
For Applicants Who do not receive a Bill or Pay Stub: If member is on COBRA, he/she must submit the monthly invoice prior to CIPA making payment. If this information is unavailable, a monthly letter or can be sent in place of the invoice.

16. Contact Information
Phone:
Fax:
Monday - Friday, 9am-6pm
Website:
Address: CIPA
41 Crossroads Plaza #110
West Hartford, CT 06117