Healthy Indiana Plan (HIP) Benefits & Services
Words to know on this page:
- Income – This is the wages or earnings you earn yearly.
- Plan – This is the health coverage you get through CareSource.
The Healthy Indiana Plan (HIP) is an insurance program offered by the state of Indiana. HIP gives health care to low-income adults. Go to www.in.gov/fssa/hip to learn more about HIP income limits.
You must let the State know about income or household changes. Go to the online benefits portal at www.fssabenefits.in.gov/bp/#/ to report changes. Or call 1-800-403-0864.
1. HIP Plus
- HIP Plus is the preferred plan. It covers all the key health benefits for a low monthly cost.
- It includes vision, dental and chiropractic services.
- It offers more physical, speech, and occupational therapy visits than HIP Basic. There are extra services like bariatric surgery and jaw care (temporomandibular joint dysfunction or TMJ).
2. HIP Maternity
Let us know if you become pregnant to get HIP Maternity benefits.
- Pregnant members do not have copays or monthly payments.
- HIP Maternity offers current benefits plus additional benefits during the HIP member’s pregnancy, and for an extra 12 months starting the last day of pregnancy. It includes vision, dental, and chiropractic services at no cost.
- It covers non-emergency rides.
- HIP Maternity can help you find ways to stop tobacco use.
HIP State Plans
HIP State Plan includes HIP State Plan Plus and HIP State Plan Basic. It is for those who need enhanced benefits. These benefits are available to those with certain medical conditions that need additional care or otherwise determined eligible by the State.
HIP Benefit Summary
Below is a list of common services under each HIP Package. Please call Member Services if you do not see the service you need. With the exception of family planning or emergency services, out-of-network health care providers need prior authorization.
| Office Visits / Hospital Visits | ||||||
|---|---|---|---|---|---|---|
| HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
| Doctor Visits | Yes | Yes | Yes | Yes | Yes | No |
Early and Periodic Screening, Diagnostic and Testing (EPSDT) | Yes, for ages up to 21 | Yes, for ages up to 21 | Yes, for ages up to 21 | Yes, for ages up to 21 | Yes, for ages up to 21 | No |
Checkups | Yes | Yes | Yes | Yes | Yes | No |
Chiropractic Office Manipulation | Yes, limit 6 per year. | No | Yes, limit 6 per year. | Yes, limit 6 per year. | Yes, limit 6 per year. | No |
Family Planning Services | Yes | Yes | Yes | Yes | Yes | No |
Clinic Services | Yes | Yes | Yes | Yes | Yes | No |
Nurse Practitioner Services | Yes | Yes | Yes | Yes | Yes | No |
Hospital Care (Non-emergency) | Yes | Yes | Yes | Yes | Yes | Inpatient: Yes Outpatient: Yes |
Pharmacy and Medicine | ||||||
|---|---|---|---|---|---|---|
HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
Preferred Drug List (PDL) Drugs | Yes | Yes | Yes | Yes | Yes | Prior authorization needed for some drugs for step therapy, quantity, or medical necessity. |
Mail Order Prescriptions | Yes | Yes | Yes | Yes | Yes | No |
Emergencies, Tests and Transportation | ||||||
|---|---|---|---|---|---|---|
HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
Emergency Services | Yes. If the service is not for an emergency the copay will be $8. | Yes. If the service is not for an emergency the copay will be $8. | Yes | Yes. If the service is not for an emergency the copay will be $8. | Yes. If the service is not for an emergency the copay will be $8. | No |
Lab and X-ray Services | Yes | Yes | Yes | Yes | Yes | No |
Emergency Transportation | Yes | Yes | Yes | Yes | Yes | No prior authorization needed for emergent ground transportation. Air transportation authorization may be obtained after the service |
Mental Health and Substance Use Services | ||||||
|---|---|---|---|---|---|---|
HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
Assessments, Screenings, & Evaluations | Yes | Yes | Yes | Yes | Yes | No. Diagnostic evaluations prior authorization is needed after one per benefit year. |
Counseling | Yes | Yes | Yes | Yes | Yes | Yes, prior authorization is needed after 20 sessions (individual, family and group) per provider per 12 month period. |
Psychiatry | Yes | Yes | Yes | Yes | Yes | No |
Intensive Outpatient Treatment (IOT) | Yes | Yes | Yes | Yes | Yes | Yes |
Partial Hospitalization Program (PHP) | Yes | Yes | Yes | Yes | Yes | Yes |
Medication Assisted Treatment (MAT) | Yes | Yes | Yes | Yes | Yes | No. Prior authorization is not needed for preferred drug. Yes. Prior authorization is needed for non-preferred drug. |
Withdrawal Management | Yes | Yes | Yes | Yes | Yes | Yes |
Substance Use Disorder Residential Treatment | Yes | Yes | Yes | Yes | Yes | Yes |
Inpatient Mental Health and Substance Use Disorder Treatment | Yes | Yes | Yes | Yes | Yes | Yes |
Dental Benefits | ||||||
|---|---|---|---|---|---|---|
HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
Oral Exams and X-Rays | Yes | No HIP Basic members age 19- 20 are eligible for (EPSDT) services and some limited enhanced preventive and diagnostic dental services. | Yes | Yes | Yes | No |
Dental Cleanings | Yes | Yes | Yes | Yes | No | |
Other Preventive Services | Yes | Yes | Yes | Yes | No | |
Minor Restorative Services (ex: Fillings) | Yes | Yes | Yes | Yes | Some services require a prior authorization. | |
Major Restorative Services (ex: Dentures) | Yes | Yes | Yes | Yes | Some services require a prior authorization. | |
Periodontal Services | Yes | Yes | Yes | Yes | Some services require a prior authorization. | |
Extractions and Oral Surgery | Yes | Yes | Yes | Yes | Some services require a prior authorization. | |
Accident or Injury Related Dental Services | Yes | Yes | Yes | Yes | Yes | Some services require a prior authorization. |
If dental services are to be performed in hospital or ambulatory surgical center, a prior authorization is required. | ||||||
Specialty Services | ||||||
|---|---|---|---|---|---|---|
HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
Routine Foot Care | Yes 6 visits per year | Yes | Yes 6 visits per year | Yes 6 visits per year | Yes | No |
Vision Care | Yes. One routine exam per year up to age 20. One routine exam every two years over age 20. One pair of glasses per year up to age 20. One pair of glasses every 5 years over age 20. | No | Yes. One routine exam per year up to age 20. One routine exam every two years over age 20. One pair of glasses per year up to age 20. One pair of glasses every 5 years over age 20. | No | ||
Skilled Nursing Facility Services | Yes, 100-day limit per benefit period | Yes, 100-day limit per benefit period | Yes, 100-day limit per benefit period. | Yes, 100-day limit per benefit period. | Yes, 100-day limit per benefit period. | Yes |
DME / Orthotics / Prosthetics | Yes | Yes | Yes | Yes | Yes | Yes |
Home Health Services | Yes, 100 Visits | Yes, 100 visits | Yes, 100 Visits | Yes, 100 Visits | Yes, 100 visits | Yes |
Hospice Care | Yes | Yes | Yes | Yes | Yes | Yes |
Medical Supplies and Equipment (e.g., hearing aids, prosthetic devices, etc.) | Yes | Yes | Yes | Yes | Yes | Yes |
Education and Training Services | Yes | Yes | Yes | Yes | Yes | No |
Non-Emergency Transportation | Yes *Added CareSource Benefit | Yes *Added CareSource Benefit | Yes *With Enhanced Benefits | Yes | Yes | No |
Therapies / Habilitative Services 60 (Basic Plan) / 75 (Plus Plan) combined visits annually for physical therapy, occupational therapy, speech therapy, cardiac and pulmonary rehabilitation | ||||||
|---|---|---|---|---|---|---|
HIP Plus | HIP Basic Copays may apply | HIP Maternity | HIP State Plus | HIP State Basic Copays may apply | Prior Authorization Needed? | |
Rehabilitation Services | Yes | Yes | Yes | Yes | Yes | Yes, prior authorization needed for some visits. |
Speech Therapy | Yes | Yes | Yes | Yes | Yes | Yes, prior authorization needed for some visits. |
Occupational Therapy | Yes | Yes | Yes | Yes | Yes | Yes, prior authorization needed for some visits. |
Physical Therapy | Yes | Yes | Yes | Yes | Yes | Yes, prior authorization needed for some visits. |
CareSource Healthy Indiana Plan (HIP) follows the instructions of the Indiana Health Coverage Program. We will let you know at least 30 days before any changes are made to benefits, how they are offered, or if prior authorization changes. All CareSource members should read anything sent in the mail or posted on www.caresource.com or the member portal to check for any changes.
Important HIP Notes
- Starting January 1, 2018, HIP State Basic and HIP State Plus will cover members age 21 to 64. All other HIP plans cover members ages 19 to 64.
- After February 2018, pregnant members will stay in HIP when pregnant and move into HIP Maternity. You will also have access to more benefits. Please contact us as soon as you know you are pregnant.
- Learn more about the Healthy Indiana Plan on the state of Indiana HIP website.