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Healthy Indiana Plan (HIP)

The Healthy Indiana Plan (HIP) is an affordable health plan for low-income adult Hoosiers between the ages of 19 and 64. It’s sponsored by the state and for some members requires a small monthly payment through your Personal Wellness and Responsibility (POWER) Account. HIP offers full health benefits including hospital care, behavioral health care for mental health and substance abuse, doctor care, prescriptions, and diagnostic care.

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Understanding your options

HIP Plus

HIP Basic

You could be eligible if:

You could be eligible if:

  • Your household income is up to 100% of the FPL.

How much do I pay?

You pay:

  • No copays for services, except nonemergent ER visits.
  • $1 to $100 per month to your POWER Account, based on your income.

You pay:

  • Copays  for most services.
  • No POWER Account contributions.

What are the benefits?

You get:

  • All medical and behavioral health benefits.
  • Maternal services.
  • Dental services.
  • Vision care.
  • Full drug benefits.

You get:

  • All medical and behavioral health benefits, including maternal services.
  • Limited drug benefits.

What you get with HIP

We’re proud to offer these benefits so you get and stay healthy. And with Anthem, you may qualify for even more!

HIP Plus members, pregnant members, and members in HIP Basic ages 19 and 20

Each year, you get:

  • Two exams and cleanings per year
  • Four bitewing X-rays per year
  • Extractions and up to four basic restorations such as fillings and one crown per year

HIP Basic

Dental benefits are offered if you’re pregnant or age 19 or 20.

For help finding a dentist in your area

Call DentaQuest toll free at 1-888-291-3762 or visit DentaQuest.

*Administered by DentaQuest, an independent company that does not provide Blue Cross and/or Blue Shield products.

HIP Plus members, pregnant members, and members in HIP Basic ages 19 and 20

  • One exam every 12 months
  • Glasses every two years
  • Contact lenses, if medically necessary

HIP Basic

Vision care is offered if you’re pregnant or age 19 or 20.

For help finding an eye doctor in your area

Call Vision Service Plan (VSP) toll free at 1-866-866-5641 (TTY 1-866-428-4833) or visit Vision Service Plan (VSP).

*Administered by Vision Service Plan (VSP), an independent company that does not provide Blue Cross and/or Blue Shield products.

In HIP, the first $2,500 of your medical expenses are paid with a special savings account called a Personal Wellness and Responsibility (POWER) Account. The state will pay most of this amount, but if you’re a HIP Plus member, you’ll be responsible for making a small contribution to your account each month. The amount will be based on your income. If you’re a HIP Basic member, you don’t pay a contribution. After the $2,500 in your POWER Account has been spent, Anthem will begin paying for your health care.

Learn more

With Anthem, you get a wide range of prescription drugs and many over-the-counter drugs. We work with Express Scripts (ESI) to provide these benefits. We can help you:

  • Understand your benefits.
  • Find an ESI pharmacy near you
  • Search the formulary for specific medications in your health plan.
  • View the preferred drug list (PDL) or group of medicines that can save you money.

You or someone you choose to act for you can send us a formulary exception request. Just email submitmyexceptionreq@anthem.com.

HIP Basic Formulary search tool
HIP Plus Formulary search tool

Referral

A referral is when your primary medical provider (PMP) sends you to another provider for care.

This care is often from a specialist. Your PMP may send you to a specialist for special care or treatment. Your PMP can:

  • Help choose a specialist to give you the care you need.
  • Help you set the day and time for the office visit with a specialist.
  • Ask Anthem is if you can get services from a specialist. Your PMP knows when to ask for a preapproval. (See below.)

Some types of services are known as self-referral services. That means you can get these services without a referral from your PMP. You can see any Indiana Health Coverage Programs (IHCP) doctor for many of these services. See your member handbook for a list of these services.

Preapproval

Some services require a preapproval or OK from Anthem. Your PMP will ask Anthem to make sure they’re offered. If they are, both Anthem and your PMP or specialist agree the services are medically necessary. Getting a preapproval will take no more than seven calendar days or, if urgent, no more than three calendar days.

These are types of services, if offered in your health plan, that need preapproval:

  • Air ambulance
  • Certain behavioral health services
  • Biofeedback
  • Drug injections
  • Dental services
  • Some equipment
  • Genetic testing
  • Home health and hospice care
  • Hyperbaric oxygen therapy
  • Infusion therapy and chemotherapy
  • Inpatient hospital services
  • Certain laboratory tests
  • Services not in your plan
  • Referrals to specialists
  • Radiology services
  • Select outpatient surgeries/procedures
  • Sensory integration therapy
  • Transplant services
  • Vision services

Your PMP will know which services need preapproval. We may not approve payment for a service you or your doctor asks for. If your case doesn’t meet the rules for medically needed, we’ll send you a letter. The letter will tell you we could not approve the service and why. The letter will also let you know how to appeal our decision if you disagree with it. For more help, please call Member Services at 1-866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 1-844-284-1797 (Hoosier Care Connect); TTY 711.

Get the most out of your health care

We know everyone’s health is different, so we offer services that keep you in mind. Through our Integrated Medical Management Model approach, we analyze information you give us, claims data, as well as an ongoing review of your health to find a care plan to fit you and your family. We also work side-by-side by your doctor, so the care meets your physical, behavioral and social needs.

Key member resources

Learn more from Indiana’s Office of Medicaid Policy & Planning (OMPP)

Find more member resources

Team up with the Indianapolis Colts!

Do you have your Blue Ticket to Health? Anthem Blue Cross and Blue Shield and the Indianapolis Colts are teaming up to help you stay healthy through the Blue Ticket to Health program. Call your doctor to schedule a wellness checkup today and enter to win!

Learn more about Blue Ticket to Health

Get your flu shot

Flu shots, pneumonia shots, FluMistTM and antiviral medications are approved benefits under most health plans. For specific information, check your member handbook or call the number on your ID card.

Make your HIP payments with MoneyGram!

To help make it easier for you to pay your POWER Account contributions, Anthem has partnered with MoneyGram. Find out more.

Earn $10 on your Anthem Rewards Card!

Just complete the Health Needs Screening. Learn more

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Do you have HIP Plus yet?

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