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 | Most of these services do not need prior authorization (except for non-emergency hospital care). Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
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 | |
Checkups | Yes | Yes | Yes | Yes | Yes | |
Chiropractic Office Manipulation | Yes, limit 6 per year. | No | Yes, limit 6 per year. | Yes, limit 6 per year. | Yes, limit 6 per year. | |
Family Planning Services | Yes | Yes | Yes | Yes | Yes | |
Clinic Services | Yes | Yes | Yes | Yes | Yes | |
Nurse Practitioner Services | Yes | Yes | Yes | Yes | Yes | |
Hospital Care (Non-emergency) | Yes | Yes | Yes | Yes | 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. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
Mail Order Prescriptions | Yes | Yes | Yes | Yes | Yes | |
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. | Prior authorization is not needed for most of these services. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
Lab and X-ray Services | Yes | Yes | Yes | Yes | Yes | |
Emergency Transportation | Yes | Yes | Yes | Yes | Yes | |
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 | Many of these services require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
Counseling | Yes | Yes | Yes | Yes | Yes | |
Psychiatry | Yes | Yes | Yes | Yes | Yes | |
Intensive Outpatient Treatment (IOT) | Yes | Yes | Yes | Yes | Yes | |
Partial Hospitalization Program (PHP) | Yes | Yes | Yes | Yes | Yes | |
Medication Assisted Treatment (MAT) | Yes | Yes | Yes | Yes | Yes | |
Withdrawal Management | Yes | Yes | Yes | Yes | Yes | |
Substance Use Disorder Residential Treatment | Yes | Yes | Yes | Yes | Yes | |
Inpatient Mental Health and Substance Use Disorder Treatment | 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 | Oral exams, x-rays and preventive services do not need prior authorization. Many of these other services do require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
Dental Cleanings | Yes | Yes | Yes | Yes | ||
Other Preventive Services | Yes | Yes | Yes | Yes | ||
Minor Restorative Services (ex: Fillings) | Yes | Yes | Yes | Yes | ||
Major Restorative Services (ex: Dentures) | Yes | Yes | Yes | Yes | ||
Periodontal Services | Yes | Yes | Yes | Yes | ||
Extractions and Oral Surgery | Yes | Yes | Yes | Yes | ||
Accident or Injury Related Dental Services | Yes | Yes | Yes | Yes | Yes | |
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 | Yes | Yes | Yes | Yes | Many of these services require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
Vision Care | Yes. One routine exam per year up to 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. | |||
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. | |
DME / Orthotics / Prosthetics | Yes | Yes | Yes | Yes | Yes | |
Home Health Services | Yes, 100 Visits | Yes, 100 visits | Yes, 100 Visits | Yes, 100 Visits | Yes, 100 visits | |
Hospice Care | Yes | Yes | Yes | Yes | Yes | |
Medical Supplies and Equipment (e.g., hearing aids, prosthetic devices, etc.) | Yes | Yes | Yes | Yes | Yes | |
Education and Training Services | Yes | Yes | Yes | Yes | Yes | |
Non-Emergency Transportation (e.g. medical visits, food, pharmacy) | Yes *Added CareSource Benefit | Yes *Added CareSource Benefit | Yes *With Enhanced Benefits | Yes | Yes | |
Therapies / Reabilitative Services Combined visits each year for physical therapy, occupational therapy, speech therapy, cardiac and pulmonary rehabilitation: 60 visits for HIP Basic 75 visits for HIP Plus | ||||||
|---|---|---|---|---|---|---|
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 | Some of these services require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. |
Speech Therapy | Yes | Yes | Yes | Yes | Yes | |
Occupational Therapy | Yes | Yes | Yes | Yes | Yes | |
Physical Therapy | Yes | Yes | Yes | Yes | Yes | |
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.