Healthy Indiana Plan (HIP) Benefits & Services

Words to know on this page:

  • Income – This is the wages or earnings you earn yearly.
  • Copay – This is the amount you pay when you get a health care service.
  • Plan – This is the health coverage you get through CareSource.
  • Personal Wellness and Responsibility (POWER) account—HIP members have a POWER Account. This is used to pay the first $2,500 in health care costs you have in a year.
  • POWER Account Contributions (PAC)—this is a monthly cost paid by HIP Plus and HIP State Plan Plus members.

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.

HIP Benefit Packages

There are five HIP plans. Read on to learn more about each plan.

Learn about all of your HIP benefits here.

General HIP Information

HIP covers all basic health benefits. Some plans may have extra benefits, like dental and vision.  HIP has a Personal Wellness and Responsibility (POWER) account. You may also have low-cost monthly POWER Account Contributions (PAC) or copays.  You do not pay any copays or PAC if you are:

  • Pregnant (including 12 months postpartum)
  • American Indian/Alaska Native

You will use POWER Account funds to pay for the first $2,500 of care you get each year. POWER Account funds cannot be used to pay for copays or PAC. Learn more in the HIP POWER Account section of this handbook.

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).
  • You do not pay out of pocket for each visit or prescription. Instead, you make a monthly PAC based on income and family size.
  • There are no copays in HIP Plus, except for $8 if you go to the ER for a non-emergency.
  • You need to make your monthly PAC by the invoice’s due date. If you stop paying, you may drop in benefits to HIP Basic. Or, you could lose all benefits.

2. HIP Basic

  • HIP Basic is a reduced plan. This is for members who do not pay their PAC and meet the income standards to keep benefits (100% and below the Federal Poverty Level (FPL)).
  • It includes basic benefits that meet coverage rules. There is also a cost to you for each service.
  •  Anyone can upgrade to HIP Plus. This can be done at certain times of the year.
  • Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
  • HIP Basic does not have standard vision or dental services. HIP Basic members age 19-20 can get EPSDT services, like vision and dental. Members 19-20 can also get some limited enhanced preventive and diagnostic dental services. It does not cover bariatric surgery or jaw care (TMJ).
  • It has less visits to physical, speech, and occupational therapies than HIP Plus.
  • If you are enrolled in HIP Basic you are not required to make monthly contributions to a POWER Account. You will need to pay the copays shown in the table below at the time of service:
ServiceCopay

Preventive care, maternity services or family planning services

$0

Outpatient services (Including Doctor Visits)

$4

Inpatient services (Including Hospital Stays)

$75

Preferred drugs

$4

Non-preferred drugs

$8

3. 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.

  1. HIP State Plan Plus: Includes all HIP Plus benefits. You do not pay out of pocket for visits or prescriptions. Instead, you make a monthly PAC based on income and family size. In HIP State Plan Plus there are no copays, unless you go to the ER for a non-emergency. You need to pay by the invoice due date. The State may move you to HIP State Plan Basic if you stop making your payments. HIP State Plan Basic has copays.
  2. HIP State Plan Basic: Also includes all HIP Plus benefits. Members in HIP State Plan Basic are not required to make monthly contributions to their POWER Account, but must pay the copays shown in the table below at the time of service:

Below is a list of common services under each HIP Package. Please call Member Services if you do not see the service you need. Except for family planning or emergency services, out-of-network health care providers need prior authorization (also called pre-approval).

ServiceCopay

Preventive care, maternity services or family planning services

$0

Outpatient services (Including Doctor Visits)

$4

Inpatient services (Including Hospital Stays)

$75

Preferred drugs

$4

Non-preferred drugs

$8

Non-emergent ER visit

$8

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 MaternityHIP 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
6 visits per year

Yes

6 visits per year

Yes

6 visits per year

Yes
6 visits per year

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 no longer have to make copayments or a monthly PAC. 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.
  • Access HIP Plus vs. HIP Basic and HIP POWER Account to learn more about HIP benefits and services.