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 | Yes 6 visits per year | Yes 6 visits per year | Yes | 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.