Hoosier Healthwise (HHW) Benefits & Services

Doctor Visits

Yes

Yes

No

HealthWatch^® –

Early and Periodic Screening, Diagnostic and Testing (EPSDT)

Yes

Yes

No

Checkups

Yes

Yes

No

Chiropractors

Yes

Yes

Yes, after initial benefit is met.

Family Planning Services

Yes

Yes

No

Clinic Services

Yes

Yes

No

Nurse Practitioner Services

Yes

Yes

No

Urgent Care Services

Yes. Urgent Care services are covered if they are medically necessary. Urgent care is needed for non-life-threatening emergencies that cannot wait for a normal scheduled office visit.

Yes. Urgent Care services are covered if they are medically necessary. Urgent care is care needed for non-life-threatening emergencies that cannot wait for a normal scheduled office visit.

No

Hospital Care (Non-Emergency)

Yes

Yes

Yes

Type of Service

Package A

Package C

Prior Authorization Needed?

Preferred Drug List Drugs

Yes

$3 copay generic, compound and sole source drugs.

$10 copay brand-name drugs.

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

Emergency Services

Yes

Yes

No

Lab and X-ray Services

Yes

Yes

No

Emergency

Transportation

Yes

$10 copay for ambulance transportation

No.

Prior authorization needed for airline or air ambulance (can get after services are rendered).
Please see Indiana Health Coverage Programs (IHCP) rules for medical necessity, special circumstances and hospital-to-hospital transfers.

Oral Exams and

X-Rays

Yes

Yes

No

Dental Cleanings

Yes

Yes

No

Other Preventive Services

Yes

Yes

No

Minor Restorative Services (ex: Fillings)

Yes

Yes

Some services require a prior authorization.

Major Restorative Services

(Ex: Dentures)

Yes

Yes

Some services require a prior authorization.

Periodontal Services

Yes

Yes

Some services require a prior authorization.

Extractions and Oral Surgery

Yes

Yes

Yes

Orthodontics

(ex. Medically necessary braces)

Yes

Yes

Yes (Age and medical necessity criteria need to be met.)

If dental services are to be performed in hospital or ambulatory surgical center, a prior authorization is required.

Anesthesia (including dental)

Yes

Yes

Yes

Nursing Facility Services
(Long Term)

Transition of Care up to 60 days.

No

N/A

Skilled Nursing Facility Services
(Short Term)

Yes, less than 30 days

No

Yes

Hospice Care

No*

No

No

Nurse Midwife Services

Yes

Yes

No

Foot Care

Laboratory services, x‑ray services, hospital stays and surgical procedures involving the foot are covered when medically necessary. No more than six routine foot care visits per year are covered. Exceptions may apply.

Laboratory services, x‑ray services, hospital stays and surgical procedures involving the foot are covered when medically necessary. Routine foot care services are not covered.  Exceptions may apply.

Yes

CareSource Life Services^® and CareSource JobConnect™, support programs for non-medical barriers

Yes

Yes

No

Home Health Services

Yes

Yes

Yes

Stop Tobacco Use

Quit Now Indiana 1-800-784-8669

Yes

Yes

No

Education / Training Services

Yes

Yes

No

Non-Emergency Transportation

Yes

No

No

DME / Orthotics/Prosthetics

Yes

Yes

Yes

Assessments, Screenings, & Evaluations

Yes

Yes

No.

Assessments and screenings do not require prior authorization.

Diagnostic evaluations prior authorization is needed after one per benefit year.

Counseling

Yes

Yes

Yes, prior authorization is needed after 20 sessions (individual, family and group) per provider per 12 month period.

Psychiatry

Yes

Yes

No

Intensive Outpatient Treatment (IOT)

Yes

Yes

Yes

Partial Hospitalization Program (PHP)

Yes

Yes

Yes

Medication Assisted Treatment (MAT)

Yes

Yes

Prior authorization is not needed for preferred drug.

Yes, prior authorization is needed for non-preferred drug.

Withdrawal Management

Yes

Yes

Yes

Substance Use Disorder Residential Treatment

Yes

Yes

Yes

Inpatient Mental Health and Substance Use Disorder Treatment

Yes

Yes

Yes

Applied Behavioral Analysis (for Autism Spectrum Disorder)

Yes

Yes

Yes

Speech Therapy

Yes

Yes

Yes

Respiratory Therapy

Yes

Yes

Yes

Occupational Therapy

Yes

Yes

Yes

Physical Therapy

Yes

Yes

Yes