Hoosier Healthwise (HHW) Benefits & Services

Doctor Visits

Yes

Yes

Prior authorization is generally not needed for these services.

PA is needed for chiropractic after initial benefit is met.

PA is needed 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

Yes

Checkups

Yes

Yes

Chiropractors

Yes

Yes

Family Planning Services

Yes

Yes

Clinic Services

Yes

Yes

Nurse Practitioner Services

Yes

Yes

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.

Hospital Care (Non-Emergency)

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. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more.

Emergency Services

Yes

Yes

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

Emergency

Transportation

Yes

$10 copay for ambulance transportation

Oral Exams and

X-Rays

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

Other Preventive Services

Yes

Yes

Minor Restorative Services (ex: Fillings)

Yes

Yes

Major Restorative Services

(Ex: Dentures)

Yes

Yes

Periodontal Services

Yes

Yes

Extractions and Oral Surgery

Yes

Yes

Orthodontics

(ex. Medically necessary braces)

Yes

Yes

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

Anesthesia (including dental)

Yes

Yes

Many of these services require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more.

Nursing Facility Services
(Long Term)

Transition of Care up to 60 days.

No

Skilled Nursing Facility Services
(Short Term)

Yes, less than 30 days

No

Hospice Care

No*

No

Nurse Midwife Services

Yes

Yes

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.

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

Yes

Yes

Home Health Services

Yes

Yes

Stop Tobacco Use

Quit Now Indiana 1-800-784-8669

Yes

Yes

Education / Training Services

Yes

Yes

Non-Emergency Transportation

Yes

No

DME / Orthotics/Prosthetics

Yes

Yes

Assessments, Screenings, & Evaluations

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

Psychiatry

Yes

Yes

Intensive Outpatient Treatment (IOT)

Yes

Yes

Partial Hospitalization Program (PHP)

Yes

Yes

Medication Assisted Treatment (MAT)

Yes

Yes

Withdrawal Management

Yes

Yes

Substance Use Disorder Residential Treatment

Yes

Yes

Inpatient Mental Health and Substance Use Disorder Treatment

Yes

Yes

Applied Behavioral Analysis (for Autism Spectrum Disorder)

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

Respiratory Therapy

Yes

Yes

Occupational Therapy

Yes

Yes

Physical Therapy

Yes

Yes