Covered Services and Contact Info for the Healthy Indiana Plan

Covered Services

HIP coverage is focused on preventive services and covers essential medical services, similar to commercial plans. The first $500 of preventative care services does not require member contributions from the POWER account. There is an annual limit of $300,000 per year for services, and a lifetime maximum of $1,000,000. Examples of covered services include:

• Physician services
• Mental health, including substance abuse treatment
• Prescriptions
• Diagnostic exams
• Home health services
• Outpatient hospital
• Inpatient hospital
• Preventive services
• Family planning
• Case management
• Disease management

Services not reimbursed under HIP include vision, dental, pregnancy, non-emergency transportation, and chiropractic services. Only hospital emergency room services are subject to a co-payment. All other provider types do not need to collect co-payments when seeing patients with HIP coverage.

Pregnancy Services

Pregnant women do not qualify for the HIP. Pregnancy services are covered by Hoosier Healthwise. If a woman becomes pregnant while enrolled in the HIP, she must submit proof of pregnancy to the State and then be transferred to Hoosier Healthwise. The provider's cooperation in educating HIP members who become pregnant and encouraging them to contact the DFR office to have their coverage changed is greatly appreciated. Doing so will also allow for timely payment of claims. Following her pregnancy, the woman may re-enroll in the HIP. A future bulletin will have more specific information, including billing procedures.

Prior Authorization

Each health plan is responsible for processing medical service prior authorization (PA) requests. Additionally, the health plans are responsible for notifying members about PA decisions.

Contact Information

For more information on HIP, visit www.HIP.IN.gov. You may also e-mail hipinfo@fssa.in.gov or call 1-877-GET-HIP9 (1-877-438-4479).

Please direct questions regarding this bulletin to EDS Customer Assistance at 1-317-655-3240 in the Indianapolis local area, or toll-free at 1-800-577-1278.