Submitting your Application

What type of information is asked for when applying to HIPP?

• Policyholder’s social security number
• Policy number & group number
• Employer & employee share of premium cost
• Client(s) name & case identification number

Besides my application, will I need to submit any other type of documents?
Yes. To process your application, we will need the following documents mailed or faxed to our program:

• A copy of the front and back of your insurance card
• Premium rate sheet provided by your Human Resources department or insurance carrier
• Summary of benefits document
• Pay stub or other proof of a premium payment

> When to Apply
> Submitting your Application
> Knowing your Eligibility

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