Healthy Indiana Plan (HIP) Benefits & Services

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 report income or household changes to the State. Go to the online benefits portal at www.fssabenefits.in.gov/bp/#/ to report changes. Or call 1-800-403-0864.

HIP Benefit Packages

The Five HIP plans:

HIP Plus | HIP Basic | HIP State Plan Plus | HIP State Plan Basic | HIP Maternity

HIP covers all essential health benefits. HIP has a Personal Wellness and Responsibility (POWER) account. Some plans may have extra benefits. You may also have low-cost monthly POWER Account Contributions (PAC) or copays. Pregnant women and American Indian / Alaska Native members do not pay any copays or PAC. Members use POWER Account funds to pay for the first $2,500 of care 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.

HIP Plus

  • HIP Plus is the preferred plan for most HIP members. 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 for up to six months.

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 requirements. There is also a member cost for each service.
  • HIP Basic members can upgrade to HIP Plus. This can be done at certain times of the year.
  • Healthwatch – Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
  • HIP Basic does not have standard vision or dental services. The plan offers some limited enhanced preventive dental services for age 19 – 20. It does not cover bariatric surgery or jaw care (TMJ).
  • It has less visits to physical, speech and occupational therapies than HIP Plus.
  • Members enrolled in HIP Basic are not required to make monthly contributions to their POWER Account, but are required to pay the following copays at the time services are rendered:

Service

Copay

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

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 enhanced benefits during the HIP member’s 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 Plus and Basic State Plan

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 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 needed. The exception is going to the ER for a non-emergency. You need to pay by the invoice due date. If you stop paying you may move to HIP State Plan Basic. HIP State Plan Basic has copays.
  • HIP State Plan Basic: Also includes all HIP Plus benefits. Members enrolled in HIP State Plan Basic are not required to make monthly contributions to their POWER Account, but are required to pay the following copays at the time services are rendered:

Service

Copay

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

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. Services provided by 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

HealthWatch –

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 Manipulation

Yes

No

Yes

Yes

Yes

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

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.

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

Prior authorization is needed but can be asked for after the service is given.

Non-Emergency Transportation

Yes

*Added CareSource Benefit

Yes

*Added CareSource Benefit

Yes

Yes

Yes.

No.

Trips over 50 miles require prior authorization.

Mental Health and Addiction Services Treatment

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, individual counseling prior authorization is needed after 24 sessions.

Yes, family counseling prior authorization is needed after 24 sessions.

No, group counseling does not need prior authorization.

Psychiatry

Yes

Yes

Yes

Yes

Yes

No

Intensive Outpatient Treatment (IOT)

Yes

Yes

Yes

Yes

Yes

Yes, prior authorization needed for all visits.

Partial Hospitalization Program (PHP)

Yes

Yes

Yes

Yes

Yes

Yes, prior authorization needed for all visits.

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, prior authorization needed for all visits.

Substance Use Disorder Residential Treatment

Yes

Yes

Yes

Yes

Yes

Yes, prior authorization needed for all visits.

Inpatient Mental Health and Substance Use Disorder Treatment

Yes

Yes

Yes

Yes

Yes

Yes, prior authorization needed for all visits.

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 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

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?

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 12-month period for members under 21 years of age.

One pair of eyeglasses per 12-month period for members under 21 years of age.

No

Vision benefit available only for members under age 20.

Yes.

One routine exam every 2 years for members 21 years of age and older.

One pair of eyeglasses every 5 years for members 21 years of age or older.

No

Nursing Facility Services

Yes,

100-day limit per benefit period

Yes,

100-day limit per benefit period

Yes

Yes

Yes

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

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 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.