Healthy Indiana Plan Members’ Common Questions
This document gives general information to help answer common questions about the Healthy Indiana Plan (HIP). For more detailed information or to get answers to any questions not listed in this document, please call (877) GET-HIP9 / (877) 438-4479 or visit www.in.gov/fssa. You can also contact MHS Member Services at (877) 647-4848. Your MHS Member Handbook includes important information regarding the HIP program, benefits, your rights and responsibilities, and recommendations to keep you and your family healthy.
General Information, Eligibility, and Enrollment
What is the Healthy Indiana Plan (HIP)?
The Healthy Indiana Plan (HIP) provides health insurance for uninsured adult Hoosiers between ages 19 to 64. Benefits last for one year, and you have to re-apply yearly. Some HIP members pay a monthly contribution towards the cost of their care. The program works much like a health savings account with a cost sharing component and a focus on preventive health. A primary goal for this HIP program is teaching members the importance of preventive health and how to better manage healthcare costs and services through a cost sharing product.
How do I apply for HIP benefits?
Please call (877) GET-HIP9 / (877) 438-4479 or visit
What happens after I am approved for HIP?
You must choose a HIP health plan. Your HIP health plan will tell you if you have to make a contribution payment. HIP members who choose MHS are “full” members, eligible to receive services if (1) they do not have to pay a monthly contribution or (2) they have made their first contribution payment to MHS.
What is a contribution?
A contribution is the monthly payment some members must pay to MHS towards their healthcare. Failure to pay a required contribution may result in the loss of HIP benefits.
How do I choose a HIP health plan?
After you are determined eligible for HIP, if you would like MHS, tell the State you want MHS to be your HIP health plan.
How does MHS help me?
MHS is a managed care entity contracted with the State of Indiana to help HIP members get needed care. We are here to help you. Periodically you will get mail, phone calls, and electronic messages from us. We will also send you important information about your HIP contribution payments (if you have a contribution), your POWER Account, preventive health services, and care you have received.
When I choose MHS, am I a “full” member right away?
You will be “fully-enrolled if (1) you are approved for HIP and do not have to pay a monthly contribution or (2) when you are approved for HIP and have made your first contribution payment to MHS.
What doctors are available to be my Primary Medical Provider (PMP)?
You may choose a doctor who specializes in family practice, general medicine, internal medicine, gynecology (women only), or endocrinology (special needs diabetics only) to become your PMP.
How do I choose a doctor?
You can pick your MHS doctor any time after choosing to enroll with MHS. If you have to pay a contribution, you must pay the contribution within 60 days of choosing to enroll with MHS, and then you will have 30 days to choose a MHS doctor. Anyone who has not chosen an MHS doctor within 30 days of becoming fully-enrolled with MHS will have a doctor picked for them.
There are four ways you can pick your doctor. (1) You can pick your doctor by calling MHS Member Services at (877) 647-4848, (2) by going to the MHS website at mhsindiana.com. (3) MHS calls you to welcome you to the HIP program, or (4) by filling out a form you receive when you get your HIP new member packet in the mail. We want you to be happy with your doctor. Please be sure to make a selection as soon as possible.
What is redetermination?
HIP members must re-enroll in HIP every 12 months. This is called redetermination. You will be notified whether you still qualify for HIP and how much your monthly contributions will be for the next year if you qualify for HIP again. You will get letters in the mail from the Division of Family Resources that tell you what to do when it is time to re-apply for HIP.
Contributions and Charges
How much will my contribution be?
The State will tell you the amount of your contributions, if you have to pay any. You will also get an invoice (a “bill”) from MHS each time a contribution payment is due.
How do I pay my contributions?
You will receive a bill for your contribution from MHS, along with information about how to pay and the due date. There are many ways you can pay your bill. (1) You can pay online by going to the MHS website mhsindiana.com, (2) by Western Union locations, (3) by mail – check or money order by mailing the payment in the envelope included with your “bill”, (4) by automatic payroll deduction, (5) by cash in-person at MHS, or (6) by electronic funds deducted from your check or bank account.
Can my employer pay part of my contributions?
Your employer may pay up to 50% of your yearly HIP contributions. Payments can be made on a monthly basis or in one lump payment. If an employer fails to make a promised payment within 60 calendar days of the due date, you have 60 calendar days afterwards to make the payment before benefits end. The forms your employer needs to fill-out to pay part of your contributions will be mailed to you with your first bill. If you need the forms or more information about how your employer can pay up to 50% of your contributions, please call MHS Member Services at (877) 647-4848.
Once your employer is set-up to make your contributions, we will send them information about when and how to make payments. We will also answer any questions they have and make sure any issues or problems are handled. If an employer paying a portion of your contribution fails to pay, then we will send you a letter allowing 60 more days to pay before notifying the State of non-payment. You are responsible for the entire payment, even if your employer is supposed to contribute but does not do so.
When do I have to pay my contributions?
You will receive a bill for your contribution from MHS along with information about how to pay and the due date. Your first contribution is due 60 days after you enroll with MHS. If you do not make your first payment on time, you will lose your HIP coverage and cannot reapply for a year.
What is a POWER Account?
You and/or the State make contributions to your Personal Wellness and Responsibility (POWER) Account. In some cases, your employer may make contributions to the account. Your POWER Account will pay for medical costs up to $1,100 per year. The cost of medical services, up to $1,100 per year is deducted from your POWER Account when you receive care. After the monthly contribution to your POWER Account is used, MHS will pay for any covered healthcare services that you get, up to $300,000 per year.
All preventive health services are fully covered when received from an in-network provider, and the first $500 of preventive health services will not be deducted from your POWER Account.
POWER Account funds may not be used to pay for non-covered services, pharmacy services, or for co-payments in the emergency room (ER). POWER Account funds can be used to pay for covered services you get outside the MHS plan.
Activity and transactions for your POWER Account can be found the MHS website, mhsindiana.com. You can also set-up your account for you to get email notifications when you can view your latest POWER Account statements. Call MHS Member Services for help getting a free email account, if you do not have one.
What is a POWER Account debit card, and what can I use it for?
Once you are fully-enrolled with MHS, you will receive a POWER Account debit card. Please keep it in a safe place. The card will serve as your HIP identification card. Remember to take it with you to every doctor’s appointment.
Your POWER Account debit card will be loaded with the money you pay monthly to your POWER Account. You must use the card to pay for covered HIP medical services until the funds are fully used. MHS pays for your covered HIP services after the funds on your debit card are gone each month. The POWER Account debit card cannot be used to pay for co-payments in the emergency room or for pharmacy services.
If you have not received your POWER Account debit card, or if you need a replacement card (at no cost to you), please call MHS Member Services or request one at the MHS website, mhsindiana.com. If you do not have to make contribution payments, you will still get a POWER Account debit card. The card will serve as your HIP identification card.
What is my HIP identification card?
Your POWER Account debit card is your HIP identification card. Present it every time you get services.
What happens after I’ve used all my POWER Account funds for the year?
MHS pays for your covered HIP services after the funds on your debit card are gone each month.
Is there a limit on how much MHS/HIP will pay for my care in a year?
Yes. The limit is $300,000 per year.
Is there a limit on how much MHS/HIP will pay for my care in my life-time?
Yes. The limit is $1,000,000.
Are there any co-pays , deductibles, or other charges for services?
HIP members are responsible for a co-pay of either $3, $6, $25, or the lower of 20% of the cost of services or $25 for emergency room (ER) services, depending on income. Your specific co-pay amount is listed on your POWER Account debit card. If a co-pay is made for these services, and you are admitted to the hospital, the co-pay is refunded to you.
Benefits and Services
How do I get care?
When you need care, contact your MHS doctor. Your MHS doctor will help you to get the care you need. If your MHS doctor’s office is closed, listen to the office phone message and follow the instructions. MHS’ NurseWise® line, staffed 24/7 by licensed nurses, is also available to help you. Just call (877) 647-4848.
Some services you can get on your own without your MHS doctor’s or MHS’ approval. These are called self-referral services and include behavioral healthcare, case management, emergency room (ER) services, family planning services, diabetic foot care, immunizations, STD treatment, and treatment for alcohol or substance abuse.
What services can I get?
Covered services include: physician services, prescriptions, diagnostic exams, home health services, specialty care, outpatient hospital, inpatient hospital, preventive services, family planning, prescriptions, and behavioral health. For a more detailed list of what services are available in the HIP program, please see “HIP Covered Services” in the MHS Member Handbook, available on the MHS website, mhsindiana.com/handbook.
- Physician Services
- Diagnostic Exams
- Home Health Services
- Family Planning Services
- Diabetic Foot Care
- Behavioral Health Care
- Substance Abuse Treatment
- Case Management
What services are not included in HIP?
HIP does not cover the following services: Maternity, prenatal, and related services, non-emergency transportation services, Hearing aids (unless 19 or 20 years old), alternative or complementary medicine, missed or canceled appointments; surgical treatment of the feet, routine foot care, dental services/orthodontics, cosmetic services/procedures, chiropractic services, treatment of sexual dysfunction, over-the-counter contraceptives, treatment of hyperhidrosis, services for learning disabilities, or vision services.
For a more detailed list of what services are available in the HIP program, please see “HIP Covered Services” in the MHS Member Handbook, available on the MHS website, mhsindiana.com/handbook.
What do I do if I have an emergency?
Go to the hospital or call 911 immediately if you think you have an emergency. A life-threatening emergency is one that is considered to a person, who possesses an average knowledge of health and medicine, to result in placing the patient in serious jeopardy, causing serious impairment of bodily function, serious dysfunction of any healthy bodily organs, or death, without treatment.
Can I get services while I’m in another State?
Yes, you can get emergency services while out of State.
What are preventive services, and why are they important?
Preventive care is key to HIP. Preventive care will lower contribution amounts for you over the next benefit year (if you must pay a contribution). Members who attain at least one of the State-recommended preventive care services are eligible to have POWER Account funds that remain at the end of the benefit year, rollover to the next benefit period. MHS will provide information to you regarding preventive care services needed by individual HIP members.
Preventive health services include annual physicals, breast (mammograms), cervical (pap test) cancer screenings, colorectal screenings, certain immunizations, and smoking cessation services. When you get preventive services, you can prevent illnesses or get earlier treatment for an illness or disease, which can lead to better overall health. All preventive health services are fully covered when received from an in-network provider, and the first $500 of preventive health services will not be deducted from your POWER Account. Below is a summary of recommended preventive health services for HIP members by age and gender:
|Preventive Care Services||Male
|Blood Glucose Screen*||X||X||X||X||X||X|
*Annual or as required by your disease/history specific condition
How will I know what preventive services I have had and which ones I need to get?
You will receive updates on the preventive services you have received and need to receive, periodically, by mail and on the secure Member Portal available at the MHS website, mhsindiana.com.
What if I become pregnant while I’m a HIP member?
Hoosier Healthwise covers pregnancy-related services, but HIP does not. If you become pregnant, you will be eligible for Hoosier Healthwise(HHW). It is important, for you be moved to the HHW program as soon as possible if you become pregnant so you can get the care you need. You should contact MHS, a caseworker with the Division of Family Resources (DFR), or your MHS doctor and let them know you are pregnant.
A Change form must be provided to DFR (your case-worker) to enroll in HHW. The form can be found on the State’s HIP page: www.in.gov/fssa/hip. You can also get a printed copy of the form by calling MHS Member Services at (877) 647-4848.
Along with the Change form, you will be asked to give proof of pregnancy. Proof can be a signed statement from a licensed health professional that includes all three of the following:
- Confirmation of pregnancy;
- The anticipated date of delivery; and
- Whether multiple births are expected.
Non-pregnancy related services will be the responsibility of HIP until your transfer to HHW is complete. You will not have to pay any POWER Account contributions while enrolled in HHW for your pregnancy. When you change from HIP to HHW benefits for your pregnancy, your POWER Account will be closed, and you will receive any funds for any balance due to you after you transfer to HHW.
You will not face any penalties for leaving the HIP program early, and you can join the HIP program with MHS again after your pregnancy ends. You will have to submit a request for re-enrollment in HIP within 60 days of the end of your pregnancy. MHS can help you complete your request for re-enrollment.
What other health care programs are available if my HIP coverage ends?
If a HIP member is eligible or becomes eligible for another Medicaid or Medicare program, he/she is required to apply. This includes Medicare for over 65 years of age and disability. Medicare will assist with your application process in the event you are approaching the age of 65. If you become disabled, there is Medicaid Disability. You will need to also apply for this program. MHS can assist you in applying for Medicaid Disability coverage. Please call (877) GET-HIP9 / (877) 438-4479 or visit www.in.gov/fssa for more information on disability or other assistance programs that may meet your needs when HIP is no longer the best option or available for your healthcare needs.
Also note, when disability (or other assistance program) coverage is approved, it usually provides a retroactive start date for disability coverage. This means you may have co-pays and you will be responsible for payments. HIP will not cover those co-pays.
When a HIP member becomes eligible for Medicare, HIP coverage ends. Medicare Part A and Medicare Part B will have different effective dates. You are encouraged to obtain your Medicare coverage and know your HIP coverage ends when Medicare starts.
It is important to review your Medicare coverage and obtain the Medicare packages that meet your needs. In some cases, you will also need a supplemental “Medigap” policy to fill the Medicare coverage gap and help you with out-of-pocket expenses such as co-pays or deductibles. Please call (800) MEDICARE / (800) 633-4227 or visit www.cms.gov/medigap/ for supplemental coverage options, www.medicare.gov for Medicare details, and www.cms.gov for general information on Medicare and other federal programs.
When your HIP coverage is no longer available or no longer your best option, these listed programs may offer you options for healthcare coverage.
What is the MHS HIP Buy-In program?
The MHS HIP Buy-In Plan is an individual health insurance plan. It is for people who are not eligible for HIP offered by the State of Indiana or applied for HIP, but were denied because the enrollment limit had been reached or there are no more funds.
If you are a member of the Buy-In Plan, you will pay a monthly contribution and will receive monthly bills from MHS to make your payments. You will receive information about your benefits, what you must pay, and what MHS will pay. Learn more about the HIP Buy-In program at mhsindiana.com
What is the Enhanced Services Program (ESP)?
This is a special plan for some HIP enrollees with certain high-risk medical conditions. HIP applicants will be screened for complex medical conditions such as cancer, HIV/AIDS, hemophilia, transplants, and aplastic anemia. HIP enrollees who qualify will be assigned to ESP.