Submitting your Application

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

  • Policyholder’s social security number
  • Policy number
  • Group number for ESI* policyholders
  • Employer & employee share of premium cost for ESI* policyholders
  • Medicaid recipient’s name & Medicaid identification number

*ESI is employer-sponsored insurance and is provided by a job.

“Besides my application, will I need to submit any other documents?”
Yes. To process your application, we will need the following documents:

• A copy of the front and back of your insurance card
• Policy rate sheet provided by your Human Resources department or insurance carrier
• Summary of benefits document for ESI* policyholders
• Pay stub or other proof that a premium payment was made

*ESI is employer-sponsored insurance and is provided by a job.

Mail or fax these documents.

“Can the Medicaid office help me apply for WV HIPP?”
Yes. Your West Virginia Medicaid eligibility worker may help you start the WV HIPP application process. For further assistance, you are welcome to contact the HIPP program.