Healthy Indiana Plan (HIP)

• Doctor care
• Hospital services
• Emergency and urgent care
• Lab tests and X-rays
• Medical supplies
• Behavioral health
• Prescription drugs
• Smoking cessation
• Transportation*

* HIP State Plan and HIP Maternity Plan members only.

See the HIP member handbook for more details.

HIP Plus

Each year, HIP Plus members can access:

• Two oral exams and two cleanings.
• One set of bitewing X-rays and one complete set of X-rays every 5 years.
• Extractions and minor restorations such as fillings.
• Major restorations such as crowns and root canals.

HIP Basic members do not have access to dental care. However, members who are pregnant or under age 21 can access dental care.

See the HIP member handbook for more details.

Help Finding A Dentist In Your Area

Call DentaQuest toll free at 888-291-3762 (TTY 800-466-7566) or visit DentaQuest.

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

Vision Benefits Are Available For The Following HIP Members

• HIP Plus
• HIP Basic members under age 21
• HIP State Plan Plus
• HIP State Plan Basic
• HIP Maternity

Eye Exams

• One eye exam per year for members under 21 years old.
• One eye exam every two years for members 21 years and older.
• Additional examinations must be medically necessary.

Eyeglasses (including frames and lenses)

One pair of eyeglasses per year for members under 21 years old, unless medically necessary under EPSDT.

One pair of eyeglasses every 5 years for members 21 years and older.

For Help Finding An Eye Doctor In Your Area

Copy Call Superior Vision toll free at 866-866-5641 (TTY 866-428-4833) or visit their website.

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.

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

Your benefits include a wide range of prescription and many over-the-counter (OTC) drugs. We work with CarelonRx to provide these pharmacy benefits.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is covered.

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. HIP Maternity members receive full comprehensive health coverage, including but not limited to:

• Prenatal services
• Vision, dental, medical, and chiropractic coverage
• Non-emergency transportation
• Behavioral health services
• Substance use disorder (SUD) services
• Smoking cessation services designed specifically for pregnant members

Pregnancy Care

As soon as you know you are pregnant:

• Call Member Services toll free at 866-408-6131 (TTY 711).
• See your doctor for prenatal care. This is the care you receive while you are pregnant. Our staff will make sure your doctor and hospital are in your plan.

While you’re in the HIP Maternity plan, you have:

• No copays.
• No POWER Account payments while you are pregnant.

After Pregnancy Care

Call us at the end of your pregnancy to let us know that you have delivered. Your extra pregnancy benefits will continue for another 12-month postpartum period. During this period, you will continue to have no copayments or POWER Account contributions.

After the 12-month period, you will transfer to HIP Basic if eligible. To switch to HIP Plus, you will need to make a POWER Account contribution within 60 days of receiving HIP Basic benefits. Members with income over the federal poverty level who do not pay for HIP Plus will lose eligibility for HIP Basic after 60 days.

On top of your regular HIP benefits, HIP Plus members can receive no-cost extras just for being our member. You can access these benefits in a few different ways.

Some extra benefits can be ordered by logging in to the secure Benefit Reward Hub. These include:

• Asthma and chronic obstructive pulmonary disease — relief products like inhalers, nebulizers, hypoallergenic bedding, and HEPA air filters (up to $80 value)
• Online fitness program and resources — through ChooseHealthy
• Pain management products — like massage tools, creams, and heating pads (up to $50 value)
• Personal care essentials — hygiene and dental products, pregnancy tests, cold and allergy remedies, and other over-the-counter items (up to $50 value)
• Transportation essentials — gas card or ride-share card (up to $50 value)

For these extras, call Member Services at 866-408-6131 (TTY 711):

• WW® (formerly Weight Watchers) — up to 13 weeks of membership
• 6-month gym membership — to a fitness center in the American Specialty Health (ASH) network
• Home-delivered meals — fresh fruits and veggies, frozen meals, or other healthy food delivered to your door
• High School Equivalency (HSE) assistance — covers the cost of the HSE test, practice test, and up to two retests
• Jump Start program — offering online learning and a job search tool
• Essentials for expectant parents — online learning courses on pregnancy and new baby care, plus items to keep parent and baby comfortable and safe.
• Transportation essentials — bus passes (up to $50 value)

Others you can access directly:

• Extra minutes for SafeLink smartphone — visit checklifeline.org to see if you qualify, then apply for SafeLink Wireless at safelinkwireless.org or call 877-631-2550
• Community Resource Link — on the Community Support page

SafeLink Wireless® is a LifeLine supported service, a government benefit program.

©2020 WW International, Inc. All rights reserved.

Limitations and restrictions apply. Benefits may change.

You can redeem some benefits online through your secure account. You may need to complete activities like an online health screening or yearly wellness or dental visit to be eligible for certain extras. View the extra benefits you are eligible for on the Benefit Reward Hub or call the Member Services number on the back of your member ID card. Log in to get started today.

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
• Certain 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
• Certain 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.