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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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Important changes to the Healthy Indiana Plan

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 

Each year, HIP Plus members get:
• Two exams and cleanings.
• Four bitewing X-rays.
• Up to four extractions and basic restorations such as fillings.
• One crown.

HIP Basic members do not get dental care, except for HIP Basic members who are pregnant or age 19 or 20.


See your member handbook for more details.

For help finding a dentist in your area

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

DentaQuest, an independent company that does not provide Blue Cross and Blue Shield products, administers dental benefits for Anthem.

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

HIP Plus members are eligible for chiropractic (back) care:

  • Six spinal therapy visits each year
  • Referrals from your doctor are not needed
  • Preapproval from Anthem is not required

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

HIP Maternity

If you qualify for HIP and you’re pregnant or become pregnant while you’re in HIP, you’ll be enrolled in the HIP Maternity plan. In this plan, you have:

  • No copays.
  • No POWER Account payments while you’re pregnant.
  • Added benefits like rides to doctor appointments and more (see your member handbook for details).

At the end of your pregnancy, you’ll receive an extra 60 days of postpartum benefits. At the end of this period, if you were in a HIP Plus plan before, you will return to HIP Plus. If you were in a HIP Basic plan, you will be eligible to choose HIP Plus.

Pregnancy care

As soon as you know you’re pregnant:

  • Call Member Services toll free at 1-866-408-6131 (TTY 711).
  • See your doctor for prenatal care — this is the care you get while you’re pregnant. Our staff will make sure your doctor and hospital are in your plan.
  • Know that while pregnant, you won’t have to make payments to your POWER Account or have copays for health care services.

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.

On top of our Anthem Rewards program, we also offer targeted incentives for members who qualify.

  • Tobacco cessation – Earn up to $40 for quitting smoking through the Quitline. Call 1-800-QUIT-NOW (1-800-784-8669).
  • HIV care – Make up to $40 per year in rewards for taking your medicine and having regular lab tests.
  • Diabetic eye exam – Members with diabetes can earn $20 by getting their yearly retinal eye exam.
  • Annual wellness exam – Just complete your annual wellness exam, and you’ll earn $20.

For more information about these programs, contact your case manager. Or call Member Services at 1-866-408-6131 (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.

Page Last Updated: 9/28/18

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