THMP – Texas Insurance Assistance Program-PLUS (TIAP-PLUS) – for Administrative Agencies and Agency Workers

HIV/STD Program

HIV/STD Program

THMP – Texas Insurance Assistance Program-PLUS (TIAP-PLUS) – Information for Clients

THMP – Texas Insurance Assistance Program-PLUS (TIAP-PLUS) – for Administrative Agencies and Agency Workers

TIAP-PLUS for ClientsTIAP-PLUS for AAs and AEWsTIAP-PLUS for Phramacies

What is TIAP-PLUS?

The Texas HIV Medication Program (THMP) can purchase health insurance for uninsured Texans living with HIV through TIAP-PLUS. TIAP-PLUS helps Texans cover out-of-pocket costs related to their overall care.
 

Who is eligible for TIAP-PLUS?

Depending on their insurance provider, participants who meet THMP eligibility criteria may be eligible for TIAP-PLUS. Clients who are already enrolled in ADAP may also be eligible for TIAP-PLUS.

To be eligible for TIAP-PLUS, clients must:

  • Submit proof of a positive HIV diagnosis.
  • Reside in the state of Texas.
  • Be otherwise uninsured or underinsured for prescription drug coverage.
  • Receive an income that is at or below 200 percent of the Federal Poverty Level (FPL).
     

What costs does THMP cover on TIAP-PLUS?

THMP covers the costs associated with the medication needs of the program participant, including:

  • Health insurance premiums,
  • Medication copayments, and
  • Medication deductibles. 
     

What costs does THMP not cover on TIAP-PLUS?

THMP and TIAP-PLUS does not cover:

  • Fines or tax obligations the participant may incur while participating in an Affordable Care Act (ACA) Marketplace Plan.
  • Medical visit deductibles or copayments. In some areas, Local Health Insurance Assistance Programs (HIA) support these costs.
  • Out-of-pocket expenses related to inpatient hospitalization, emergency care, or other medical services.
  • Expenses for other family members or dependents.
  • Costs related to free-standing vision or dental plans.
  • Other costs outside of those outlined above under the “What costs will THMP cover on TIAP-PLUS?” Section.
     

What are the TIAP-PLUS Enrollment Requirements?

When choosing a health insurance plan, TIAP-PLUS applicants must adhere to the following requirements:

  • Applicants must be eligible for THMP and maintain active THMP eligibility.
  • Applicants must be eligible for the plan they wish to enroll in, as determined by the ACA Marketplace or other insurance plan eligibility requirements.
  • Applicants cannot select a Consolidated Omnibus Budget Reconciliation Act (COBRA) plan if they qualify for a more cost-effective health insurance plan.
  • If eligible, applicants must accept the monthly Advanced Premium Tax Credit to help pay for insurance premiums.
  • If applicable, the applicant must accept cost-sharing reductions and enroll in a silver plan.
  • The applicant must enroll in a THMP pre-approved plan or submit a different plan for THMP program approval before enrollment.
    • If the applicant enrolls in a plan before THMP approves it, there is a chance that the plan will not qualify for THMP.
  • The Agency Eligibility Worker (AEW) should help clients choose the best plan for them:
    • The clinic where the client receives care should accept the plan.
    • THMP also approves the plan.
       

Which health insurance plans does TIAP-PLUS cover?

To qualify for coverage under TIAP-PLUS, applicants must enroll in plans that meet the following criteria:

  • Be a qualified health plan as defined by HealthCare.gov.
  • Have appropriate primary care services, including the medical location where the applicant receives HIV medical care.
  • Have at least one drug in each class of core antiretroviral therapeutics from the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.
  • Include the prescription medications the applicant needs, especially those for HIV treatment.
  • Include a Ramsell participating pharmacy convenient to the applicant’s physical location.
  • Be cost-effective, as determined by THMP.

Clients should contact their local HIV service provider to ensure they accept the plan they would like to choose.

The insurance plan's website will provide a complete list of covered medications the client can review before enrollment.

If you or the client have any questions about acceptable insurance plans, please contact THMP.
 

What if the plans used by clinics in my area are not on the pre-approved list?

If a client’s insurance plan is not on the list of pre-approved plans, please contact THMP at 800-255-1090. THMP will review the client’s plan and notify you and the client if it falls within the program's eligibility guidelines for coverage. 
 

What if the participant is enrolled in insurance already? Can we transfer them?

If the client meets the THMP eligibility guidelines as outlined under the “What is TIAP-PLUS?” section, and the client’s existing Marketplace insurance plan falls under the list of pre-approved plans, they can enroll in TIAP-PLUS by registering and applying on TakeChargeTexas (TCT).

If the client’s insurance does not fall under the list of pre-approved plans, please contact THMP at 800-255-1090 before THMP registration. 
 

How does an applicant apply for TIAP-PLUS?

Before applying for TIAP-PLUS, an applicant must enroll in a qualified health insurance plan.

You or the applicant can contact THMP at 800-255-1090 option 4, then option 1, with questions about the TIAP-PLUS application process. Local HIV service agencies can also assist with THMP application submissions.

To apply for TIAP-PLUS, you or the applicant must:

  • Go to TakeChargeTexas.gov to register and apply.
  • Select “TIAP-PLUS” from the My Needs page in the TCT portal.
  • Under contact preferences, select “mail” and “phone.” THMP will need to contact the applicant during the enrollment process.
  • If needed, contact THMP at 800-255-1090, option 1 for a paper application.
  • The applicant must submit a copy of their insurance premium billing statement or agreement as part of the TIAP-PLUS application.
    • The billing statement must clearly display the client’s mailing address and insurance identification numbers.
       

My client entered “no mail” on their TIAP-PLUS application. What should I do?

You must emphasize that the insurance company will mail the client's insurance cards to the mailing address on file. This is a program requirement.
 

My client does not want to transition from ADAP to TIAP-PLUS, even though they are eligible for insurance. Can they continue using ADAP?

The client can continue using ADAP. However, we encourage you to emphasize that, if the client enrolls in TIAP-PLUS, they will:

  • Have access to other medications outside the THMP formulary,
  • Be able to arrange medication delivery or pick up medications from their pharmacy on weekends,
  • No longer be required to wait for medications to be mailed to them, and
  • Be insured for preventative care.

Additionally, since TIAP-PLUS will cover the clients’ insurance premiums, medication copays, and medication deductibles for all prescription drugs.
 

What will happen when my client is approved for TIAP-PLUS?

Ramsell Corp will send a welcome letter to the client after they are approved for TIAP-PLUS. The welcome letter will include the client’s Ramsell Copay Card. The Ramsell Copay Card will look like the sample picture below and list the following information:

Ramsell card front

Figure 1: Ramsell Card (Front)

Ramsell card back

Figure 2: Ramsell Card (Back)

Every client as an identification number unique to them, but the Group, Plan, Rx Bin, and Rx PCN remain the same across all Ramsell Copay Cards for TIAP-PLUS.

The client will present this card along with their insurance card when filling prescriptions at a Ramsell-participating pharmacy. Clients will not owe any money when picking up their prescriptions. Watch the video below to learn more.

Please remember: Ramsell makes medication copayments for eligible THMP enrollees. To maintain Ryan White payer of last resort requirements, agencies must coordinate with any existing payers. In this case, THMP is the existing payer. Please coordinate with THMP by assisting clients with enrolling in Local Health Insurance Assistance (HIA) to cover medical out-of-pocket expenses not covered by THMP.

All prescription medications should be processed through Ramsell-participating pharmacies with ACA insurance and Ramsell benefits. Patient assistance cards, including e-vouchers, may not be used for THMP Ramsell participants. THMP Ramsell coverage includes medications for the treatment of HIV and any other prescriptions covered under the client’s health insurance plan.
 

How can I learn more about THMP?

For more information, visit the Texas HIV Medication Program.
 

Supporting Documents