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 秋葵app.

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 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 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 秋葵app

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

Prior authorization needed for some drugs for step therapy, quantity, or medical necessity.

Mail Order Prescriptions

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.	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 秋葵app Benefit	Yes *Added 秋葵app 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.

秋葵app 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 秋葵app 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 .

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