| (4) HHSC may reimburse an employee for the employee's
portion of the ESI premium up to three months after the month the
premium was paid for currently enrolled individuals; HHSC does not
reimburse employees for proof of payments received after three months
from the date the premium was paid.
(f) HHSC notifies Medicaid individuals in writing in
the following circumstances:
(1) After review of a complete application, HHSC provides:
(A) eligibility approval for the HIPP program, including
the premium reimbursement amount to be paid; or
(B) denial of eligibility for the HIPP program, including
the reason for the denial.
(2) At yearly renewal or when the HIPP program has
identified potential changes to an individual's ESI, family, or Medicaid
status, HHSC provides a request for information.
(3) When HHSC has identified an overpayment, HHSC provides
notice of the overpayment and repayment options.
(4) When HHSC receives notification that a HIPP program
premium reimbursement was not received, HHSC provides a stop payment
request which must be completed and returned to HHSC before HHSC issues
a replacement check.
(g) Overpayments.
(1) HHSC recovers identified overpayments as a result
of erroneous HIPP program reimbursements.
(2) HHSC notifies individuals in writing that a HIPP
program overpayment has occurred.
(3) If the HIPP program overpayment is not refunded
to HHSC prior to the next scheduled HIPP program reimbursement, HHSC
automatically deducts the overpayment from the next scheduled HIPP
program reimbursement and each month following until the overpayment
has been fully refunded to HHSC.
(4) An individual enrolled in the HIPP program, or
an employer with an employee enrolled in the HIPP program, must notify
HHSC of any known HIPP program overpayments.
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