Member Information for Healthy Indiana Plan
Member Information
As an MDwise Healthy Indiana Plan (HIP) member, remember these basic rules:
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You can only choose and change your doctor by talking with MDwise. Call MDwise customer service right away and confirm your doctor.
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Carry your member ID card with you at all times. Show your card every time you get health care.
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Contact your doctor first for all medical care. Only go to the emergency room for true medical emergencies.
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Make sure MDwise always has your correct address and phone number. This will help us contact you about you and your family’s important health care information.
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You must get preventive health care and check-ups each year you have coverage to qualify for POWER Account rollover.
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You must pay your monthly contribution to stay in HIP Plus. If you do not make your monthly POWER Account contribution on time, you may be disenrolled or moved to HIP Basic, depending on your income.
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Some services need approval from MDwise before you get them. This is called prior authorization. For more information, see the Healthy Indiana Plan member handbook.
Member Handbook
The MDwise member handbook is the best place to go to understand your benefits and services. You receive this handbook when you become a MDwise member. Please review it carefully. It has a lot of important information to help you to get the health care you need.
Review your member handbook for important information
Member Handbook (English) | Member Handbook (Spanish).
The MDwise member handbook has information about:
Provider Member Management Forms
Reporting Changes
New Address or Phone Number
If you move or change your phone number, you must let the Division of Family Resources (DFR) know. You can do this online here.
Log in to the system to make your change. If you don't have a login, click on the blue "sign up for a new account" button. You can also call 1-800-403-0864 to make the change.
Other Insurance Plans
If you have other health insurance, please call 1-800-403-0864 to report this.
Please call MDwise is any of these things happen:
- You get hurt in a car wreck.
- You get hurt at work.
- You get hurt and someone else may have to pay.
If you are involved in an accident, subrogation communication should be sent to:
Multiplan
Phone: 866-223-9974
Fax: 866-297-3112
Address: 535 Diehl Road, Suite 100, Naperville, IL 60563
Medically Frail
Members with certain health conditions may be eligible for enhanced benefits. MDwise will monitor your health conditions and let you know if you qualify for these benefits. If you think you have a health condition that may qualify please call MDwise customer service. An individual may be considered medically frail if he or she has any of the following:
- Disabling mental disorder;
- A chronic substance abuse disorder;
- Serious and complex medical conditions;
- Physical, intellectual or developmental disability that significantly impairs the individual’s ability to perform one or more activities of daily living; or
- A disability determination based on Social Security Administration criteria.
If you have a condition, disorder or disability, as described above, you may receive additional benefits called the HIP State Plan benefits. The HIP State Plan benefits grant you comprehensive coverage including vision, dental, non-emergency transportation and chiropractic services. These HIP State Plan benefits will continue as long as your health condition, disorder or disability status continues to qualify you as medically frail. MDwise may contact you annually to review your health condition. It is important to answer any questions to maintain HIP State Plan benefits. If you fail to verify your condition at the request of MDwise, you could still have access to comprehensive coverage including vision and dental, by participating in HIP Plus, but you would lose access to the additional HIP State Plan benefits including coverage for non-emergency transportation and chiropractic services. If you have questions or you have changes in your health condition, please contact MDwise customer service.
Changing Your Contribution Amount
If your family or income size changes while you are on the Healthy Indiana Plan, you must report this change. Some examples of this are when there is a birth, death, divorce or when someone moves in or out of your household. You should report any job loss or income change while you have HIP coverage. If your family size has increased or your income has decreased, your contribution amount may be recalculated at a lower rate. Please call 1-800-403-0864 to report this type of change.
Reporting Fraud
You can report fraud and abuse by calling MDwise customer service. You do not have to give your name. If you do, the provider or member will not be told that you called.You also can send an email to our fraud investigation team at SIU@MDwise.org, or leave us an anonymous voice message on our Compliance Hotline, 317-822-7400.
Examples of health care provider fraud and abuse are:
- Billing or charging you for services that MDwise covers.
- Offering you gifts or money to receive treatment or services.
- Offering you free services, equipment or supplies in exchange for use of your Hoosier Healthwise or Healthy Indiana Plan number.
- Giving you treatment or services that you do not need.
- Physical, mental or sexual abuse by medical staff.
- Billing or charging for a treatment, service or supply that is different than what you received.
Examples of member fraud and abuse are:
- Members selling or lending their identification cards to people not covered by Hoosier Healthwise or the Healthy Indiana Plan.
- Members abusing their benefits by seeking drugs or services that are not medically necessary.
Help MDwise Stop Fraud and Abuse
- Do not give your member ID card or MDwise card number to anyone. It is okay to give it to your doctor, clinic, hospital, pharmacy, Hoosier Healthwise, Healthy Indiana Plan or MDwise customer service.
- Do not let anyone borrow or use your member ID card.
- Do not ask your doctor or any health care provider for medical care that you do not need.
- Work with your primary doctor to get all of the care that you need.
- Do not share your Hoosier Healthwise, Healthy Indiana Plan or other medical information with anyone except your doctor, clinic, hospital or other health provider.
If you have questions or concerns about fraud and abuse, call MDwise customer service.
Cost of Care Care
It is important to know what your medical services cost.
You may want to know the cost of a medical service before you go to the doctor. Then you will know how much will be taken out of your POWER Account each time you get medical care. You can download and print the MDwise list of common medical services and estimated reimbursement rates.* You can also call MDwise customer service at 800-356-1204.
If you want to know about a specific service that is not listed, please call MDwise customer service and we will research it for you. We will call you back to let you know the estimated reimbursement for that service.
*Please note that these costs are estimates.
POWER Account Statements
You will get a POWER Account statement each month. This statement will tell you what services you have received and what was taken out of your POWER Account to pay for them.
You can sign up to get these monthly statements online through myMDwise. You can earn MDwiseREWARDS points if you sign up. Learn more about MDwiseREWARDS.
MDwise Has Special Recognition
MDwise Hoosier Healthwise and Healthy Indiana Plan are accredited as a health plan by the NCQA (National Committee for Quality Assurance). This means that the NCQA reviewed the care and services that MDwise offers. NCQA has very high standards for quality. The NCQA evaluation is well-known throughout the country.
We want to give our members the best care. NCQA recognition shows that MDwise is committed to quality care. It also shows that we protect our member’s rights. You will see a special seal on many MDwise materials you receive. Only health plans that have passed the NCQA review can use this seal.
MDwise Annual Review of Care
MDwise wants to make sure you receive the care and services that you need. Every spring we conduct a review of medical claims and records called HEDIS (Healthcare Effectiveness Data and Information Set). This monitors how well we are doing. This is part of NCQA accreditation.
Some examples of the type of care we review include:
- Well-care visits for children.
- Pregnancy care.
- Care for specific conditions like diabetes.
HEDIS results help MDwise know where we are doing well. It also lets MDwise know where we need to improve.
Member Surveys and Outreach
Your opinions are very important to us. MDwise sends out a member satisfaction survey every year. This survey is called CAHPS (Consumer Assessment of Healthcare Providers and Systems). These surveys are first sent by mail. A follow-up call is made if we do not get a response in the mail. This survey lets us know how MDwise members feel about the care they are getting. It helps us know what we are doing well and where we need to improve.
Members may also get phone calls from MDwise. One type of call might be to check on your health needs. Your answers help us know which programs might be right for you. Another type of call might remind you about important preventive care. Any MDwise caller will tell you right away who they are and why they are calling.
Culturally and Linguistically Appropriate Services (CLAS)
MDwise wants to be sure that you get services that are right for you based on your culture. We want to be sure that you can speak to providers in your own language. We also want members to understand their health care. It is important that you have things explained in a way that you can understand.
MDwise uses the CLAS standards as a guide. These are national standards from the Office of Minority Health. They were created for health care providers and organizations. We ask members and providers for information about their race, ethnicity and language to help meet culture and language needs. We work on finding providers with different backgrounds in order to offer a diverse provider network. We have bilingual staff and phone interpreters to help us talk to members in their own language. We offer training to staff and providers on a regular basis to help meet your needs.
Steps to Wellness Newsletter
The MDwise Steps to Wellness newsletter provides information on Hoosier Healthwise and HIP benefits. It also includes helpful tips for you and your family on how to stay healthy. A new version is published every three months.
2023
2022
Download Audio Newsletter
2021