Applying for HIPP

There are three ways to apply for AL HIPP benefits! You can:

Fill out and submit an online application,
Print an AL HIPP application and mail or fax your completed application, or
Call 1-855-MyALHIPP (1-855-692-5447) to start your application over the telephone.

Apply today!

Send your completed application and documents by:

Fax: 1-855-357-1130, or
Mail: AL HIPP Program
P.O. BOX 240756
Montgomery, AL 36124

You must be able to provide the following Information:

• Policyholder’s Social Security number
• Policy number & group number of the group insurance
• Employer & employee share of premium cost
• Medicaid recipient(s) name & Medicaid identification number(s)

Along with your application, you must provide a copy of:

• Insurance card (front and back)
• Summary of benefits for your plan or desired plan
• Employer health insurance rate sheet (proof of the cost for group health insurance)
• Paystub if it shows premium deduction

Note: We only accept copies of the front and back of your insurance card. Please do not send us your original card in the mail.

Remember, if you have questions or need help, you can call us to start your application over the phone at 1-855-MyALHIPP (1-855-692-5447).