Healthy Indiana Plan (HIP)

Click on any of the links below to learn more.
 



BENEFITS

 

Healthy Indiana Plan has several benefit plans. Here is a brief description of these benefit plans. More specific details about each of these benefit plans and limits are on the following pages. It is important that you read these specific details to understand your coverage. 
 

HIP Plus

 

This is a preferred plan for all HIP members. HIP Plus provides the best value coverage including: 

  • Members pay a low monthly contribution based on their income. 
  • No copays (except for improper emergency room use). 
  • More extensive pharmacy options. 
  • Dental services (for more information see page 24). 
  • Vision services. 
  • Chiropractic services. 


You do not have to pay any other costs or copayments unless you visit the emergency room when you don’t have a true emergency health condition. 

If both you and your spouse are enrolled in a HIP Plus plan, the monthly contribution amount will be shared between the two of you. For more information about POWER Account monthly contribution see pages 18-23
 

HIP Basic 

 

HIP Basic benefits provide coverage for all required services but these services are limited and do not provide dental or vision coverage along with other benefits. Members do NOT make a POWER Account contribution, but have copayments for services. You will need to make a payment almost every time you get health care service, such as going to the doctor, filling a prescription or staying in the hospital. 

  • Copayments range from $4 to $8 per doctor visit or prescription filled. 
  • Copayments can be as high as high as $75 per hospital stay. 
  • Plan maintains essential health benefits, but incorporates reduced benefit coverage (for example, fewer therapy visits). 
  • Does not include vision or dental coverage (except for 19–20 year olds). 
  • Limited pharmacy options. 


HIP Basic can be more expensive than paying your monthly HIP Plus POWER Account contributions. 
 

hip-basic-icon.pngMembers who don’t pay their POWER Account contribution on time and are not eligible for HIP Basic will be locked out of the HIP program for six months. This lockout will not apply if you are medically frail, living in a domestic violence shelter or in a state declared disaster area. If your income is below 100 percent of the federal poverty level you may be eligible for HIP Basic. 

If you fail to make your first POWER Account contribution and you are ineligible for HIP Basic, you will have to re-apply for HIP to gain coverage.
 

HIP State Plan Plus 

 

HIP State Plan Plus gives you a different set of benefits that works best for your situation or medical condition for a low predictable monthly cost. You can only qualify for this plan if you have certain health conditions or situations. HIP State Plan Plus provides the best value coverage. HIP State Plan Plus allows you to receive these benefits by making a monthly contribution to your POWER Account based on your income. 

  • Members pay a low monthly contribution based on their income. 
  • Pharmacy. 
  • Transportation services are covered (for more information see page 26). 
  • No copays (except for improper emergency room use). 
  • Dental services, vision services and chiropractic services. 


For more information on covered benefits see pages 13–14
 

If both you and your spouse are enrolled in a HIP Plus plan, the monthly contribution amount will be shared between the two of you. For more information about POWER Account monthly contribution see pages 18–23
 

HIP State Plan Basic 

 

HIP State Plan Basic offers enhanced benefits such as vision, dental and chiropractic services. However, you will need to make a payment called a copayment for most health care services you receive, such as going to the doctor, filling a prescription or staying in the hospital. 

  • Copayments range from range $4 to $8 per doctor visit or prescription filled. 
  • Copayments can be as high as $75 per hospital stay. 


HIP State Plan Basic could cost you more than paying the HIP State Plan Plus monthly POWER Account contribution. 
 

HIP Maternity Plan 

 

You must call FSSA or MDwise as soon as you find out you are pregnant. If you are pregnant when you apply and get accepted to HIP, you’ll automatically be put in the HIP Maternity plan.

While on the HIP Maternity plan, you will not have to make your POWER Account payment or pay copayments. You will have pregnancy benefits and additional benefits such as transportation.
 

You will receive at least 60 more days of HIP Maternity coverage after your pregnancy ends. When your pregnancy ends, report it to FSSA immediately at 1-800-403-0864.

pregnancy-icon.pngMembers who become pregnant will automatically be put on the HIP Maternity Plan. While on the HIP Maternity Plan, you will not pay any copays or POWER Account Contributions. Services you receive while on HIP Maternity will not come out of your POWER Account.

 

HIP Benefit Summary


The chart below is a benefit summary for Healthy Indiana Plan members. Please note, once you have spent all of the funds in your POWER Account, then MDwise pays 100 percent of all covered services. If you use up all your POWER Account funds you will not earn bonus dollars to get a cheaper contribution next year. See pages 18-23 for details.

handbook-hip-benefits-summary.png

Back to top


COVERED MEDICAL SERVICES FOR HIP MEMBERS

 

MDwise wants to help you stay healthy. That is why we cover preventive care as well as sick care. If there are changes to your benefits, we will let you know by mail. It is important for you to know that your ID card still works, even if your benefit plan changes. The card is good until you are not enrolled with MDwise in the Healthy Indiana Plan. If you have any questions about your benefits, please talk to your doctor or call MDwise customer service.
 

It is also important to understand your Benefit Year and Eligibility Period (also known as Redetermination Period). Benefit Year starts January 1 and ends December 31 each calendar year. Eligibility Period (Redetermination Period) is 12 months from when you are approved for coverage. This can be different for each person. 
 

Benefit Year: 

  • IMPORTANT: You must participate in the annual Eligibility (Redetermination) process. 
  • Your Benefit Year does not change if you leave the HIP program and return during the year.
  • Your benefit limits and POWER Account reset every year in January.
  • The HIP Health Plan Selection Period is every year from November 1 - December 15. During this time, you will have the chance to stay with your current health plan or change your health plan for the next benefit year. 
    • NOTE: If you like MDwise you do not need to take any action to stay with your current health plan. Your MDwise coverage will automatically continue into the next benefit year. 
  • MDwise is committed to serve your health care needs.
  • If you want to change your health plan you can contact the enrollment broker at 1-877-438-4479 during the annual Health Plan Selection Period which is November 1 – December 15 of every year.
  • You must get your preventive services within the Benefit Year to qualify for rollover of any funds left in your POWER Account. See pages 18-23 for detailed POWER Account information. 

Eligibility (also known as Redetermination) Period:
  • You can buy-in to HIP Plus during the Eligibility Period.
  • If you do not participate in the annual Eligibility (Redetermination) process, you may be locked out of the HIP program for up to 6 months.
  • Letters for your eligibility will come from the Indiana Family and Social Services Administration (FSSA). 
  • See page 27 for more information on the Eligibility (Redetermination) Period.

 

Preventive Care

 

Getting regular preventive care is the key to better health. You get preventive care when you go to the doctor for check-ups and other well care. MDwise covers preventive care because it keeps you healthy and checks for problems before they become serious. In addition, if you complete your preventive care services, your future POWER Account contributions could be reduced. See pages 18-23 for detailed Power Account information. Examples of preventive care include:

  • Check-ups and shots.
  • Physical exams.
  • Mammograms and Pap smears.
  • Eye care exams.
  • Dental exams.


See page 3 for more information about preventive care.
 

Necessary Care

 

Care must be “medically necessary.” This means it is:

  • Needed to diagnose or treat you.
  • Proper based on current medical standards.
  • Not more than what is needed.
 

Prior Authorization
 

Some services need approval from MDwise before you get them. This is called prior authorization. If your doctor does not get prior authorization when it is needed, MDwise will not pay for the services. Prior authorization decisions are based only on the appropriateness of care and services. These decisions are also based on whether or not you have coverage.

 

The prior authorization departments are available via a toll-free number from 8 a.m. to 5 p.m. Monday through Friday, excluding holidays. The language line is available to assist non-English speaking callers. The prior authorization department is available to answer any questions regarding a specific prior authorization request. They can also answer general questions regarding prior authorization. Your health care provider will contact the prior authorization department on your behalf to ask questions regarding prior authorization or request a prior authorization. If you call the toll-free number after hours or on a holiday or weekend, a voice recording is available and all messages are returned the following business day.
 

Your Doctor Must Approve and Refer You to these Services

 

Members can get the full list of services on the following page. Your doctor must approve all these services. To get the following services, you must call or go to your doctor first. The doctor will refer you for any treatments you need.
 

Doctor Care:

Physical exams.

Primary care.

Preventive care.

Specialty care.
 

Hospital Care:

Inpatient services.

Outpatient services.

Diagnostic services.

Lab tests and X-rays.

Post-stabilization services.
 

Medical Supplies:

Prescriptions.

Durable medical equipment. 

Hearing Aids (one every five years).
 

Other:

Health care screenings and diagnosis.

Home health care therapy, including:

  • Physical therapy.*
  • Speech therapy.*
  • Occupational therapy.*

Renal dialysis.

Smoking cessation.

Disease management.

Lead screening for 19 and 20 year olds.

Hospice services.

Eye care (excluding HIP Basic members).

Skilled nursing facility.*

Dental services (excluding HIP Basic members).

Transportation for pregnant members and HIP State Plan members. 
 

* Limitations apply depending on your plan. See below for details.

If you have questions about your benefit package call MDwise customer service.

handbook-hip-doctor-approved-services.png

Back to top


SERVICES FROM OTHER PROVIDERS FOR HIP MEMBERS

 

Sometimes, you may need to see a provider other than your regular doctor. 
 

Seeing a Specialist

 

A specialist is a doctor who treats one part of the body, like the heart, skin or bones. Your regular doctor will write you a referral if you need to see a specialist. That specialist will be in the MDwise network. 

If MDwise does not have the doctor that you need in our network, or if the doctor is not within 60 miles of your home (there are some specialists who will be within 90 miles of your home), we may authorize out-of-network doctors to take care of you. These providers must be Indiana Health Coverage Program or Medicaid providers.
 

You Must Get a Referral From Your Doctor Before Going to a Specialist

 

MDwise will not cover specialist care unless you have a referral from your doctor. Your doctor will tell you how to get specialist care.
 

Self-Referral Services

 

The table below outlines the self-referral services for each HIP health plan.
 

handbook-hip-services-from-other-providers.png
 

Services Outside MDwise

 

For most services you need to go to a MDwise provider. For some services, you can go to any HIP provider. If you get these services, please let your doctor know. This helps them take care of you. You do not have to get all of your Healthy Indiana Plan Maternity services from MDwise.
 

The services that you may get outside of MDwise are:

  • Pharmacy services (See page 17 for more information).
  • Dental services (See page 24 for more information).
 

Services Not Covered 

 

The following services are not covered under the Healthy Indiana Plan:

  • Long-term care services.
  • Bariatric surgery (not covered for HIP Basic).
  • Services provided in an intermediate care facility for the mentally retarded (ICF/MR).
  • Psychiatric treatment in a State hospital.
  • Services under the home and community-based services (HCBS) waiver.
  • Services that are not medically necessary.
  • Dental services (not covered for HIP Basic).
  • Conventional or surgical orthodontics, or any treatment of congenitally missing, malpositioned, or super numerary teeth, even if part of a congenital anomaly.
  • Vision services (not covered for HIP Basic).
  • Elective abortions and abortifacients.
  • Non-emergency transportation services (i.e., transportation services that are unrelated to an emergency medical condition) (Not covered for HIP Basic and HIP Plus).
  • Chiropractic services, except for those services covered under the plan that are within the scope of practice of a chiropractor (e.g., physical therapy) (Not covered for HIP Basic).
  • Drugs excluded from HIP.
  • Experimental and investigative services.
  • Day care and foster care.
  • Personal comfort or convenience items.
  • Cosmetic services, procedures, equipment or supplies, and complications directly relating to cosmetic services, treatment or surgery, with the exception of reconstructive services performed to correct a physical functional impairment of any area caused by disease, trauma, congenital anomalies or a previous medically necessary procedure.
  • Safety glasses, athletic glasses and sunglasses.
  • LASIK and any surgical eye procedures to correct refractive errors.
  • Vitamins, with the exception of vitamins included through the pharmacy benefit.
  • Wellness benefits other than tobacco cessation.
  • Diagnostic testing or treatment in relation to infertility.
  • In vitro fertilization.
  • Gamete or zygote intrafallopian transfers.
  • Artificial insemination.
  • Reversal of voluntary sterilization.
  • Transsexual surgery.
  • Treatment of sexual dysfunction.
  • Body piercing.
  • Over-the-counter contraceptives.
  • Alternative or complementary medicine including, but not limited to, acupuncture, holistic medicine, homeopathy, hypnosis, aroma therapy, reiki therapy, massage therapy and herbal, vitamin or dietary products or therapies.
  • Treatment of hyperhidrosis.
  • Court ordered testing or care, unless medically necessary.
  • Travel related expenses including mileage, lodging and meal costs, except for mileage paid to emergency transportation providers.
  • Missed or canceled appointments for which there is a charge.
  • Services and supplies provided by, prescribed by, or ordered by immediate family members, such as spouses, caretaker relatives, siblings, in-laws or self.
  • Services and supplies for which an enrollee would have no legal obligation to pay in the absence of coverage under the plan.
  • The evaluation or treatment of learning disabilities.
  • Routine foot care, with the exception of foot care for individuals with lower extremity circulatory disorders including diabetes.
  • Surgical treatment of the feet to correct flat feet, hyperkeratosis, metatarsalgia, subluxation of the foot and tarsalgia.
  • Any injury, condition, disease or ailment arising out of the course of employment if benefits are available under any Worker’s Compensation Act or other similar law.
  • Examinations for the purpose of research screening.
 
Back to top

 


HIP PHARMACY SERVICES

 

medicine-icon.pngMedicines for MDwise Healthy Indiana Plan (HIP) members are covered. You can go to any MDwise participating pharmacy that accepts Indiana Medicaid. If you have pharmacy questions or problems, please call 1-844-336-2677
 

When you or your child needs medicine or over-the-counter items, your doctor will write a prescription. You can take that prescription to a participating pharmacy. 
 

HIP Members 

 

If you have Internet access, you can go to MDwise.org/members and choose your plan, to look up a medication on the formulary. The formulary also tells you some over-the-counter medicines and vitamins that are covered. The complete formulary list is available online at MDwise.org under Pharmacy Services. 

You can also visit MDwise.org/findadoctor, then choose “Find a Pharmacy,” to see a list of participating pharmacies. If you need help, you can call MDwise customer service at 1-800-356-1204
 

HIP Pharmacy Services 

 

MDwise Healthy Indiana Plan (HIP) covers necessary medicines. Your doctor must prescribe these medicines. The medicine must be approved by the Food and Drug Administration (FDA). You can go to any MDwise participating pharmacy that accepts Indiana Medicaid. If you have pharmacy questions or problems, please call MDwise customer service and choose the pharmacy option. The phone number is located on the back of your ID card. 
 

When you need medicine, your doctor will write a prescription. You can take that prescription to any MDwise participating pharmacy. 
 

You will not have copays for your prescription medicine if you are a member of one of these plans: 

  • HIP Plus. 
  • HIP State Plan Plus. 


You will have copays for your prescription medicine if you are a member of one of these plans: 

  • HIP Basic. 
  • HIP State Plan Basic. 
 

HIP gives your health care provider a tool called a formulary. This helps them prescribe drugs for you. A formulary is a list of the brand and generic medicines covered by HIP. This drug list also tells you some over-the-counter medicines and vitamins that are covered. MDwise HIP members can call 1-844-336-2677 or go to MDwise.org/hip/pharmacy for more information or to find a list of pharmacies. You can also call MDwise customer service at 1-800-356-1204

phone-icon.png
TIP:
If you need help finding a pharmacy, call MDwise customer service.

 


Prior Authorization of Prescription Drugs for HIP Members 

 

For safety reasons, some prescription drugs, need approval from MDwise before you get them. This is called prior authorization. If your doctor does not get prior authorization when it is needed, MDwise will not pay for the prescription. Prior authorization decisions are based on the appropriateness of care and services or safety reasons. These decisions are also based on whether or not you have coverage. Doctors and staff who make prior authorization decisions do not get incentives or rewards for making these decisions. They do not get payment for deciding to deny a service, or for making decisions that may make it harder to get care and services. 

Back to top


HIP POWER ACCOUNT

 

POWER Account Contributions

 

money-icon.pngIn the HIP program, the first $2,500 of medical expenses for covered services are paid with a special savings account called a Personal Wellness and Responsibility (POWER) Account. The state will contribute most of this amount, but you will also be responsible for making a contribution to your account each month. Your monthly contribution amount depends on your income level. If both you and your spouse are enrolled in a HIP Plus plan, the monthly contribution amount will be shared between the two of you. HIP Basic members will not make contributions to their POWER Account.
 

Your POWER Account contribution is 1 of 5 amounts, depending on your household income. This is measured by a comparison to the Federal Poverty Level (FPL). For example, if you make 48% of the FPL, or about $1,000 per month for a family of four, you would pay $5 per month.

HIP-POWER-account-contributions.png

Effective 1/1/2019: All HIP members (Plus and Basic) can contribute no more than five percent of their family income. These contributions include POWER Account contributions and copays. If a HIP Plus member’s total contribution is more than five percent of their individual income, the member will only have to pay the $1 minimum contribution to maintain HIP Plus enrollment. See page 30 for more information about reporting changes in income.

The state calculates the individual’s POWER Account contribution during the application process. Contributions are also recalculated by the state before a new coverage term begins (benefit year), to account for any changes in the member’s income. If some or all of a member’s POWER Account balance is rolled over at the end of the coverage term, the annual amount of the member’s POWER Account contribution for the new coverage term will be reduced by that account balance.

POWER Accounts are funded by both the state and the member. Members are encouraged to seek help from their employer or other third party organization. An employer or other third party organization can assist with some or all of the member’s POWER Account contribution. Employers or other third parties interested in providing assistance can find more information by visiting MDwise.org/employer-thirdparty or by calling MDwise customer service.

As a member of the Healthy Indiana Plan, there are special rules to follow. Once you are eligible for the Healthy Indiana Plan, you will get a letter that lets you know what your monthly contribution is. You must pay this each month. Members who are pregnant or identified as an American Indian/Alaska Native are exempt from payment of a contribution for HIP Plus. If you do not pay your contribution each month you may be disenrolled from the program or moved to HIP Basic, depending on your income. If your income level is less than 100 percent of the U.S. Federal Poverty Level (FPL) you will be moved to HIP Basic. If you don’t make your payments and your income is more than 100 percent of the FPL you will be disenrolled. We will send you a POWER Account Statement each month to remind you. If you are on HIP Plus and lose coverage due to non-payment, you cannot re-enroll for six months unless you qualify for an exemption. If you have recently obtained and later lost private coverage, had a loss of income after disqualification due to increased income, moved to another state and later returned, are a victim of domestic violence, resided in a county subject to a disaster declaration, or are medically frail, you may be entitled to a HIP Non-Payment exemption.
 

Tobacco Use Surcharge


HIP members: If you use tobacco, you have 12 months to stop tobacco use or you may have a higher POWER Account contribution. If you don’t stop using tobacco, your POWER Account contribution payment may have a 50 percent surcharge. For example, if your current monthly POWER Account contribution is $10 a month, and if you do not stop using tobacco within 12 months of your coverage starting, your contribution may go up to $15 a month, the next year.

Tobacco use means the use of tobacco 4 or more times a week in the last 6 months. This includes the use of chewing tobacco, cigarettes, cigars, pipes, hookah and snuff. It does not include the use of nicotine delivery devices.

If your tobacco status changes, please call MDwise customer service.
 

Ways to Pay Your POWER Account


There are a number of ways you can make your monthly POWER Account contribution:

  1. Check or Money Order. Make your check or money order payable to MDwise and mail your payment to: MDwise HIP Contributions, P.O. Box 714407 Cincinnati, OH 45271-4407.
    • Important note: All checks and money orders are held for 10 days to allow them time to clear. Please keep this in mind when mailing your contribution.
  2. Cash. Please do not mail cash. Below are the ways you can make your monthly contribution by cash:
    • Use MoneyGram. You can make your POWER Account contribution using cash in person at a MoneyGram location at no cost. Find a MoneyGram location at www.MoneyGram.com/BillPayLocations. There are more than 41,000 locations inside retailers like Walgreens, Walmart and many more. Bring the following things with you:
      • Enough cash for your payment.
      • Your MDwise Member Identification Number (MID) found on your member ID card.
      • Receive Code: 15187.
    • Complete the MoneyGram ExpressPayment® blue form, use the red MoneyGram phone or use the MoneyGram kiosk to complete your transaction. (Payment processes may vary depending on your location. Simply ask an associate for help.)
    • Pay at any Key Bank location. Please call the Key Bank Billing and Collection customer service at 866-539-4092 to request payment slips and obtain complete instructions on how to make cash POWER Account contributions with Key Bank.
  3. Employer/Other Third Party Contribution. Ask your employer or other third party about paying some or all of your contribution. If they agree to help pay your contribution, the Employer/Third Party Contribution form must be filled out. This form can be found on our website at MDwise.org/employer-thirdparty. An employer or other third party can assist by paying some or all of your monthly POWER Account contribution. If your employer or other third party pays only part of your contribution, you will get a bill each month for the rest.
  4. Payroll Deduction. Ask your employer if you can have your HIP contribution taken from your paycheck. If so, your employer will need to complete the Direct Deposit Form and follow instructions on remittance to Key Bank. Employers may contact customer service at 1-866-539-4092 for assistance.
  5. WISEpay. You can submit payment online with a credit card or arrange for an automatic withdrawal from a designated bank account (electronic funds transfer). You can do this through myMDwise by visiting MDwise.org and clicking on the MDwise WISEpay link. For general billing or payment help, or if you need help with your online payment, please call WISEpay customer service at 1-866-539-4092.
  6. Phone. You can also make contribution payments with a debit or credit card by phone. Call our automated Billing and Payment Center at 1-866-539-4092.
    • If other members of your household are HIP members, you can make a payment for each person all at once. Remember, each HIP member has their own account number and each member has their own payment amount.
    • If paying by mail:
      • Please send in the payment slip for each member making a payment. This way each member’s account will show that a payment was made correctly.
      • Please make sure that the total dollar amount matches the amounts due from each of the payment slips.
      • Please include each account number on the check. • Mail payments to the address listed on the slip.
      • Please include your Member Identification Number (MID) on all checks or money orders to ensure timely application to your account. 
    • Your Hoosier Healthwise and Healthy Indiana Plan You will get a bill or invoice for your contribution each month. The invoice will tell you the different ways you can make your payment. It will also tell you how much you need to pay.
    • Paying with myMDwise:
      • Create a myMDwise account by going to MDwise.org/myMDwise. You can sign up to get your monthly invoice online through myMDwise.
      • Once you sign up we will email you each month when your invoice is ready.
      • Log on to your myMDwise account to get your invoice and pay your monthly contribution.


Please Pay Monthly Contributions On Time!


hip-basic-icon.pngHIP Plus members must pay their monthly contributions on time. MDwise provides many payment options to help members make their contributions on time. Depending on your income, if you do not pay your monthly contribution you will be moved to a different HIP plan or lose coverage. If you don’t pay your contribution within 60 days and your income is below the federal poverty level (FPL), you will be moved to HIP Basic. If you do not pay your contribution within 60 days and your income is above the FPL, you will be disenrolled. If you are disenrolled you lose all coverage and can not re-enroll in HIP for six months. Re-enrollment lock-out will not apply if you have recently obtained and later lost private coverage, had a loss of income after disqualification due to increased income, moved to another state and later returned, are a victim of domestic violence, resided in a county subject to a disaster declaration or are medically frail.

HIP Basic has minimum coverage benefits and requires copays for all covered medical services except preventive care. Because this plan requires copays for medical services, the HIP Basic plan may be more expensive than paying your monthly POWER Account contributions for HIP Plus, which has more benefits.


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 1-877-438-4479 to find out more. See pages 28-30 for information on reporting a change.
 

MDwise Healthy Indiana Plan Card


You will get a MDwise ID card in the mail. Use this MDwise ID card whenever you go to the doctor, the pharmacy or anytime that you get health care services. If you lose your card call MDwise customer service. We will replace your card at no cost to you.

id-card-hip-(1).png
 

POWER Account Reconciliation for HIP Members


Termination Once you become fully eligible and end your coverage with HIP, or fail to renew your coverage at the end of 12 months, the following steps are taken to settle your $2,500 POWER Account to the State:
  1. MDwise will gather your benefit period, enrolled covered months and reason for termination. If you were a HIP Plus member and stopped paying your monthly contribution any leftover funds will receive a 25 percent penalty and you will only receive 75 percent of any applicable refund amount. If your coverage ends for any other non-penalty reason, 100 percent of eligible member funds will be evaluated for refund.
  2. If you were a HIP Plus member, MDwise will gather all contributions paid into the POWER Account by you, your employer, any third party individuals on your behalf, and the State. If your account shows an excess in contributions received, called overpayments, you may request a refund at any time during the year or excess member contributions will automatically be refunded at the end of the calendar year or benefit period.
  3. MDwise will gather all claims paid from the POWER Account and whether or not you had preventive services.
  4. Whether you were enrolled with MDwise for one month or all twelve months, MDwise will determine if the contributions paid cover your required portion of claims responsibility. If you were a HIP Basic member then your HIP POWER Account was paid entirely by the State and no further action is needed. If you were a HIP Plus member and paid more than what was needed to cover your claims responsibility you will receive a refund. If you paid less than what was needed to cover your claims responsibility the debt will remain on your account until it is paid off. If you paid exactly what was needed to cover your claims responsibility no further action is needed.


Transfer


Applicable only for benefits periods beginning 2/1/2015 thru benefit periods ending 12/31/2018. Effective 1/1/2019 transfer transactions will be treated like a term transaction.

Once you become fully eligible and transfer from MDwise to another plan at the end of your benefit period, the following steps are taken to settle your $2,500 POWER Account to the State of Indiana:
  1. MDwise will gather your benefit period and covered months of enrollment with MDwise.
  2. MDwise will gather all contributions paid into the POWER Account by you, your employer and any third party entity on your behalf and the State.
  3. MDwise will gather all claims paid from the POWER Account and whether or not you had preventive services.
  4. MDwise will determine if the contributions paid cover your required ratio of claims responsibility. The resulting information will be sent to your new plan.


Rollover


Once you become fully eligible and renew your coverage, the following steps are taken to settle your $2,500 POWER Account from the prior period to the State:
  1. MDwise will gather your benefit period and enrolled covered months.
  2. If you were a HIP Plus member, MDwise will gather all contributions paid into the POWER Account by you, your employer, any third party entity on your behalf and the State.
  3. MDwise will gather all claims paid from the POWER Account and whether or not you had preventive services.
  4. If your POWER Account has a $0 value, no further action is needed. However, if there is a positive balance leftover in your account, MDwise will run the rollover process.

Members ending their prior benefit period as HIP Plus:
  • Member Rollover – You get to reuse these dollars to reduce the amount owed for your current benefit period. Unused member rollover dollars will be kept and used in future benefit periods. Member Rollover dollars can be used to pay off existing debt on account or to pay tobacco surcharge amounts. To align with the 5 new POWER Account values based on FPL bands (0-22% pay $1 up to 101-138% pay $20); Member Rollover earnings will be limited to a maximum of $240 beginning with Rollover POWER Account reconciliations for calendar year 2018 and beyond. Excess member rollover will refunded to member.
  • State Rollover – If you also received preventive services, the State matches your member rollover dollar amount and provides extra funds for you. These funds will be used to further reduce the amount you owe for the current benefit period but only after member rollover dollars are used up. State Rollover is NEVER used to pay tobacco surcharge amounts. Unused State Rollover funds are returned to the State at the end of the current benefit period.

Members ending their prior benefit period as HIP Basic:
  • State Rollover Discount PercentageIf you also received preventive services, you will earn a state discount equal to the percentage of claims leftover in your POWER Account. The maximum discount percentage is 50 percent. The discount is applied to reduce the possible plus payment amount due to move you from the HIP Basic to the HIP Plus plan. If you choose NOT to pay for plus at this reduced rate, the State’s rollover discount is lost for the rest of the current benefit period. HIP Basic members who do NOT get preventive services will not earn the State rollover discount.
  • Members who choose to remain BASIC will incur a 25% penalty on any unused Member Rollover dollars. Only 75% of remaining Member Rollover dollars will be carried forward to your new coverage year.


How to Know What Medical Services Cost for HIP Members


money-icon-(1).pngEven though preventive services are free for MDwise HIP members and will not come out of your POWER Account, it is important to know what your medical services costs. That way you will know how much is going to be taken out of your POWER Account each time you get medical care. If you want to know costs before you get a medical service, please go to the MDwise website at MDwise.org /HIP/cost-of-care. We have posted a list of common medical services and their costs. You can also call MDwise customer service and we can mail you a list of common services and their costs. 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 cost for that service.

Your monthly POWER Account 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. See page 52 for details.

Back to top

 


HIP DENTAL SERVICES


MDwise uses a company called DentaQuest to provide your dental services under the Healthy Indiana Plan. Dental care is very important for your health and wellbeing. You need to have regular check-ups every six months at your dentist’s office. Dental exams count as a preventive service.


Contact DentaQuest


phone-icon.pngCall DentaQuest for information regarding eligibility, finding a doctor, benefits or any dental-related questions. You can reach DentaQuest toll-free at 1-844-231-8310. Hours are Monday through Friday from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call 1-800-466-7566.


Find a Dentist


To find a participating dentist near you, visit MDwise.org/findadoctor. Under “Healthy Indiana Plan Members,” select “Find a Dentist.” You can also call toll-free 1-844-231-8310 and we will help you find a dentist.

To receive dental benefits, make sure the dentist is a participating provider in the network. If you receive services from an out-of-network dentist, you may be responsible for the full payment of the dentist’s charges.


Benefit Summary


Your dentist will tell you if the dental care you need is covered and going to be paid for by your dental plan. HIP Basic and HIP State Plan Basic members will have copays for dental services. The table at the bottom of this page includes some dental services covered for each HIP Health Plan.


Dental Services Not Covered


Your dentist can tell you the full list of services covered by the Healthy Indiana Plan. You can also call MDwise customer service for the list of services covered.


Dental Limits


There are no dental cost limits or maximums for the Healthy Indiana Plan.


Emergency Dental Care


dental-icon.pngIf you experience dental pain, call your dentist right away. Your dentist will arrange to see you as soon as possible. You can also call the MDwise NURSEon-call line to speak with a nurse. You should not go to the emergency room for dental pain unless your dentist, doctor or NURSEon-call tells you to.

dental-table.png

Back to top

 


HIP EYE CARE


Eye care benefits are available for members in the following plans:
  • HIP Plus.
  • HIP Basic members ages 19–20.
  • HIP State Plan Plus.
  • HIP State Plan Basic.
  • HIP Maternity.


Getting Eye Care Services


eye-icon.pngTo get eye care services, you can call an eye doctor (either an optometrist or ophthalmologist). Eye care exams count as a preventive service. The eye doctor must be contracted with the state of Indiana. When making an appointment be sure to ask if the office is contracted with the state of Indiana. You can search for eye care providers at MDwise.org/findadoctor. You can also call MDwise customer service and we can help.


Benefit Summary


HIP Basic and HIP State Plan Basic members may have copays for vision services.

Eye Exams
  • One eye exam per year for members under 21 years old.
  • One eye exam every two years for members 21 years of age or older.
  • Additional examinations must be medically necessary.

Eyeglasses (including frames and lenses)
  • One pair of eyeglasses a year for members under 21 years old.
  • One pair of eyeglasses every five years for members 21 years of age or older.
  • Repairs or replacements of eyeglasses for reasons that are beyond your control. Examples include fire, theft or a car accident.

Back to top

 


HIP TRANSPORTATION SERVICES


Rides to Your Doctor


car-icon.pngMDwise covers transportation to doctor and dentist appointments for HIP State Plan Plus and HIP State Plan Basic. You can get transportation if you are a pregnant HIP member and you have called to let us know you are pregnant.

MDwise covers 20 one-way rides to and from your doctor or clinic each year. You should save your trips for when you cannot get a ride any other way. If available in your area, MDwise may give you a bus pass for your trip to the doctor. A bus pass counts as two trips towards your trip limit. If there are any extra trips on the bus pass, you can use them to go to other important appointments.

You should only take an ambulance when it is a true emergency. If you think your problem could cause lasting harm or loss of life, call 911.

MDwise does not cover trips to the pharmacy.


Scheduling a Ride (non-emergency)


You should call MDwise to arrange a ride the same day you make your doctor’s appointment. If you forget, you must call at least two business days before the doctor’s appointment to get a ride. For example, if your appointment is on Wednesday, you must call by Monday at the latest. Weekend days and holidays do not count. If you need an urgent trip, let us know.

phone-icon.pngTIP: Don’t forget to call for your ride as soon as you set up your doctor appointment. If you cancel or change your appointment, call MDwise right away to cancel or change your ride.


If you have used up your 20 one-way rides, or if you need transportation further than 50 miles from your home or outside of Indiana, you will need to call MDwise for prior approval for the trip. This means a nurse will need to approve the trip based on medical necessity. If this is the case, call at least three days before your appointment to schedule your transportation. That allows MDwise time to get your trip approved.

When you call for a ride, you should:
  1. Schedule your appointment with your doctor or dentist before you call to schedule a ride.
  2. Have your MDwise member ID card ready. You will also need to know:
    • Your address and phone number.
    • Date the ride is needed.
    • Time of the doctor appointment.
    • Name, address and phone number of the doctor or clinic.
    • Total number of passengers.
    • Time you think the visit will end.
  3. Call MDwise customer service to reserve your ride. Listen carefully and pick the transportation option. You must call between 8:00 a.m.–8:00 p.m., Monday through Friday.
  4. Members must call the MDwise customer service transportation line for a return ride from their appointment, NOT the transportation company.

WHO CAN GET TRANSPORTATION? 
The following members can get rides:
  • Any pregnant HIP Member.
  • Any member in HIP State Plan Plus.
  • Any member in HIP State Plan Basic.

Back to top

 


HIP MEMBER REDETERMINATION


Healthy Indiana Plan members must re-enroll every 12 months. This is called redetermination. The process will determine if you are still eligible for the Healthy Indiana Plan. It will also determine your monthly POWER Account contribution for the next year.

Forty-five days days before your coverage ends, you will get a letter from the Division of Family Resources with information about how to enroll for the next year. Please be sure to answer all the questions related to your re-enrollment. Please read this information VERY carefully. If you have questions about it, feel free to call us.

If you have to fill out the form, mail it back to:

FSSA Document Center
P.O. Box 1810
Marion, IN 46952


It is very important that you fill out the re-enrollment form right away and send it in. You can also fax the completed form to 1-800-403-0864. The Division of Family Resources must get this completed form at least 15 days BEFORE your coverage term ends or you will be disenrolled from HIP.

If you need help filling out this form, please call us. We are happy to help you. If you do not get this form by 60 days prior to your re-enroll date, call 1-877-438-4479 to request a new one be sent to you.

Back to top

 


HIP MEMBERS MOVING TO DISABILITY OR MEDICARE COVERAGE


hip-basic-icon.pngAll HIP members are required to apply for another Medicare program if they are eligible or become eligible for one. This includes Medicare for people over 65 years of age and disability. Medicare will assist with your application process if you are getting close to the age of 65. If you become disabled, there is Medicaid Disability. The Healthy Indiana Plan will assist you on the next steps in applying for Medicaid Disability coverage. Please call 1-877-438-4479 or go to in.gov/fssa. You can get more information on disability or other assistance programs that may meet your needs when HIP is no longer the best option or is no longer available for your health care needs. When disability (or other assistance program) coverage is approved, it will usually have a retroactive start date for coverage. This means you may have copays and you will be responsible for payments. HIP will not cover those copays.

When a HIP member becomes eligible for Medicare their HIP coverage ends. Medicare Part A and Medicare Part B will have different start dates. You are encouraged to get your Medicare coverage and know when your HIP coverage ends, and when your Medicare starts. You are also encouraged to think about “Medigap” coverage. This is extra coverage that will help pay for things Medicare does not fully cover. It is important to review your Medicare coverage and get the best Medicare packages that meet your needs. In some cases, you will also need an extra “Medigap” policy. This will help fill the Medicare coverage gap and help you with things you have to pay such as copays or deductibles. Please call 1-800-MEDICARE (1-800-633-4227) or visit cms.gov/Medigap for extra coverage options. For general information about Medicare and other federal programs you can go to medicare.gov and cms.gov.

When your HIP coverage is no longer available or no longer the best option, the above programs may offer you other health care coverage options.

Back to top

 


CHANGES YOU MUST REPORT AND DOCTOR AND PLAN CHANGES FOR HIP MEMBERS


New Address or Phone Number


If you move or change your phone number, you must let the Division of Family Resources (DFR) know. Go to www.in.gov/fssa/dfr/2999.htm. Click on “Manage Current Benefits.” Log in to the system to make your change. You can also call the DFR at 1-800-403-0864 or call MDwise customer service. We can help.


Other Insurance Plans


If you have other health insurance, you must let us know. You must also tell us, and the Healthy Indiana Plan (1-877-438-4479), if:
  • You have changes in your insurance.
  • You get hurt in a car wreck.
  • You get hurt at work.
  • You get hurt and someone else may have to pay.


Medically Frail


hip-basic-icon.pngMembers 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 they have 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 Doctor


If you are not happy with your health care or your doctor, please call MDwise. We will work with you to fix any problems you have.

We can also help you change doctors, such as when:
  • You have moved.
  • Your doctor has moved or no longer belongs to MDwise.
  • Your doctor does not return your calls.
  • You have trouble getting the care you want or your doctor says you need.
  • Your doctor was assigned by MDwise before you had the chance to choose a doctor for yourself.
  • Other reasons—call for more information.

To change your doctor or to ask for a list of doctors in your area, please call MDwise customer service. You can also go to MDwise.org/findadoctor to get a list of MDwise doctors. Remember, it is better for your health to stay with one doctor, rather than changing doctors often.


Important Information About MDwise Doctors


You can find information about MDwise doctors at MDwise.org/findadoctor. This will tell you many things about doctors and other providers. This includes:
  • Practice location.
  • Phone number.
  • If they are on a bus line.
  • Languages they speak.
  • And more.

If you have questions about the quality of MDwise providers please ask us. You can call MDwise customer service and we can research specific doctors for you. The information we give you might include credentialing status and board certifications, licensure and accreditation information, and complaint history. You can also find quality information on facilities, such as hospitals, in the MDwise network. Go to MDwise.org/findadoctor where we have links to information about hospitals. This information is collected nationally by the Department of Health and Human Services. Remember, it is better for your health to stay with one doctor, rather than to change doctors often.


Changing Your Plan


We hope you are happy with the services you receive from MDwise. If you are not happy please call MDwise customer service and we will try to help. If you are eligible to change your plan, you can do so by calling 1-877-438-4479.

You can change your plan:
  • Before you make your initial POWER Account contribution to become effective.
  • During the Health Plan Selection Period.
  • If there are quality of care problems that we cannot fix for you.
  • If you become pregnant and choose to switch from your HIP plan to HIP Maternity.

You can also ask to change your health plan at any time if you have “just cause.” The just cause reasons include:
  • The health plan does not have access to medically necessary services covered.
  • The health plan does not, for moral or religious reasons, cover the service you need.
  • You need related services to be performed at the same time; not all related services are available within the health plan network; and your primary medical provider or another provider believes that getting the services separately would subject you to unnecessary risk.
  • The health plan is disciplined by the Office of Medicaid Policy and Planning.
  • The health plan does not have providers experienced in dealing with your health care needs.
  • Poor quality of care. Poor quality of care includes failing to meet established standards of medical care and significant language or cultural barriers.
  • The member’s primary care provider (PMP) leaves the health plan, and the health plan cannot choose a new PMP suitable for the member’s needs.
  • The health plan provides limited access to a primary care clinic or other health services within reasonable proximity to the member’s home.
  • Your Hoosier Healthwise and Healthy Indiana Plan If you think you have a “just cause” reason, you must first contact MDwise, so that we can try to resolve your concern.

If you are still unhappy after contacting us, you can contact the Healthy Indiana Plan by phone at 1-877-Get-HIP9 (1-800-438-4479) or by mail at:

Healthy Indiana Plan
PO Box 441410
Indianapolis, IN 46244


The Healthy Indiana Plan will review your request and help you obtain the form to submit the change.


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 1-877-438-4479 to find out more.


What To Do If You Pay More Than Five Percent of Your Individual Income


If you have paid for health care over five percent of your income in a given calendar quarter (every three months of coverage beginning on first effective date), let us know. This money must have been paid by you or another family member for:
  • Monthly contributions for your HIP coverage.
  • Copays.
  • CHIP premiums.
  • Debt repayments.

If these things add up to more than five percent of your income in a given calendar quarter, you may not have to pay future copays. HIP Plus members will only have to pay the $1 minimum contribution to maintain HIP Plus enrollment. If you think this is true for you, we will track this for you during your MDwise enrollment. If you disagree with the total or have health expenses for other members of the family then we will need to see copies of receipts to confirm.

Requests and documentation can be sent to:

MDwise Customer Service
P.O. Box 44236
Indianapolis, IN 46244-0236


We will review all of your documents. We will confirm whether you have paid over five percent of your income during a three month calendar quarter. We will then let you know the outcome of our review.

Back to top


GATEWAY TO WORK


phone-icon.pngGateway to Work is a part of the Healthy Indiana Plan (HIP). It connects HIP members like you with ways to look for work, train for jobs, finish school and volunteer. Starting in 2019, you might be required to do Gateway to Work activities to keep your HIP benefits. The Indiana Family Social and Services Administration (FSSA) will give you your Gateway to Work status. Your status will be Reporting, Reporting Met or Exempt.

If your Gateway to Work status is “Reporting,” you need to meet a required number of activity hours each month and report them. There are many things you can do to meet the requirement. Activity hours must be reported using the FSSA Benefits Portal or by calling MDwise. MDwise can answer questions or connect you with new activities.

At the end of the year, we will look at all the hours you reported and determine if you met your required hours each month. You will need to meet the required monthly hours 8 out of 12 months of the year to keep your HIP benefits. Contact MDwise if you have questions about Gateway to Work.


Information on Gateway to Work Status


Any HIP member can do the Gateway to Work program but some HIP members are required to do it. Based on the information you have reported to FSSA, a Gateway to Work status has been assigned to you. Every HIP member has one of the following status assignments for Gateway to Work:

Exempt – “Exempt” means you meet an exemption for Gateway to Work. You are not required to participate during months you are exempt, but you can if you want to.

Reporting Met – “Reporting Met” means you do not meet an exemption, but already work at least 20 hours per week. You do not need to do anything new for Gateway to Work unless you report a change of employment to FSSA.

Reporting – “Reporting” means you are required to do Gateway to Work. You will have to work, attend classes or volunteer and report those activities each month through the FSSA Benefits Portal. You can also call MDwise to report your hours.

Your status may change during the year if you have a change in your work or school status, or if you start or stop meeting an exemption.


Gateway to Work Member Status Notification


FSSA will mail you a letter with your Gateway to Work status. To check your Gateway to Work status, call MDwise customer service at 1-800-356-1204, or 317-630-2831 in the Indianapolis area, log on to the FSSA Benefits Portal, or look at your monthly POWER Account statement (beginning in March 2019).


Hours Required To Meet the Requirement


computer-icon.pngIf your Gateway to Work status is “Reporting,” you need to report activity hours each month using the FSSA Benefits Portal. You need to report the type of activity, date, location and the number of hours completed. For help entering Gateway to Work information, you can contact MDwise or work with a Gateway to Work partner. Please go to www.HIP.in.gov and click on “Gateway to Work” for more details.


Schedule of Timeframe for Monthly Required Hours


Gateway to Work’s required activity hours will increase on a set schedule. This is designed to give you time to learn about the program, contact your health plan, find Gateway to Work partners and activities you can do, and set up your FSSA Benefits Portal account. After July 1, 2020, the required activity hours reach 80 hours per month.

If your Gateway to Work status is “Reporting,” you will need to do qualifying activities for a certain number of hours each month. Hours do not carry over from month to month. The number will start at zero in January 2019 and increase as shown below:
gateway-to-work-hours.png

For example, in July 2019, if you do 5 hours of activities each week, you will meet the 20 hour requirement for the month. When the requirement goes up in October 2019, if you do 10 hours of activities each week, you will meet the 40 hour requirement for the month.


Exemptions


If your Gateway to Work status is “Exempt,” you are not required to participate in Gateway to Work for the months you are exempt, but you can participate if you want to. Exemptions include:
  • Age 60 years and older.
    • Your exemption starts the month you turn 60 years old.
  • TANF or SNAP recipient.
    • All months you are receiving TANF (cash assistance) or SNAP (EBT card) benefits.
  • Medically frail.
    • All months you have been determined medically frail by your health plan.
  • Pregnant.
    • All months you are pregnant beginning the month you get pregnant and then for 2 months after delivery.
  • Homeless.
    • All months you are homeless or do not have stable housing.
  • Institutionalized.
    • Within the last 30 days, all months you have been in a hospital or facility for more than 1 day.
  • In treatment for a substance use disorder.
    • All months you are in substance abuse or addiction treatment.
  • Recently incarcerated (for a period of at least 30 days in the past 6 months).
    • If you have been in prison or jail for at least 30 days in the last 6 months, you are exempt the month you are released and the 6 months following your release.
  • Certified temporary illness or incapacity.
    • All months you have a temporary illness or incapacity determined by the following:
      • You have an inpatient hospital stay covered by HIP.
      • You have an illness or injury certified by your doctor.
  • Caregiver:
    • All months you are a primary caregiver for the following.
      • A dependent child under 7 years old (a dependent is your biological child, stepchild, foster child, sibling, step-sibling, grandchild, step-grandchild or other relative).
      • A disabled dependent (a dependent is your biological child, stepchild, foster child, sibling, step-sibling, grandchild, step-grandchild or other relative).
      • Kinship caregiver of an abused or neglected child (kinship caregiver means you are a relative to this child).
  • Student (half or full-time).
    • All months you are enrolled and attending, a postsecondary educational institution (like college) or vocational school. Half time is 2 classes in a long semester or 1 class in a short semester.
  • Other possible exemptions will be reviewed for good cause on an individual basis.

If you meet one of the above listed exemptions and have not been given a Gateway to Work status of “exempt,” you need to call MDwise.


Qualifying Activities


You may meet your required number of hours by doing any of the activities below. You can earn hours in more than one category. For example, in one month you could go to job training for 5 hours and volunteer for 5 hours to earn 10 hours.

Work
  • Employment.
    • Employed or self-employed and receiving wages.
  • Job search activities.
    • Such as going to job fairs, applying for jobs, reviewing online job postings or writing your resume.
  • Education related to employment.
    • On-the-job training.
  • Homeschooling.
    • You homeschool your child in the home setting, meeting all legal requirements for homeschooling.
  • Members of the Pokagon Band of Potawatomi participating in the tribe’s comprehensive Pathways program.

Learn
  • Adult education.
    • Preparing to take the High School Equivalency test.
    • Attending educational classes beyond high school (postsecondary education like college).
    • Attending other general education classes or training from a not-for-profit, public institution or Gateway to Work partner.
      • Activity hours includes class time, study time and travel time.
  • General education.
    • Such as taking a budgeting, computer skills, gardening or cooking classes.
  • Job skills training.
  • Vocational education or training.
  • English as a Second Language education.

Serve
  • Volunteer work.
    • Such as helping at your children’s school, your church or helping people in your neighborhood.
  • Community service/public service with any organization.
    • Volunteering through an established nonprofit organization.
  • Community work experience.
    • A program offered by a Gateway to Work partner that would provide you with general skills, knowledge and work habit training.
  • Caregiving services.
    • Such as helping a person with a chronic, disabling condition.

Other activities may be accepted based on individual review.


How to Report Gateway to Work Activity Hours


To report an activity, you will need the type, date, location and the number of hours completed. It is best to report hours as soon as you finish an activity to make sure you do not forget, but you can report at any time after the activity is complete. You will need to report all activity hours completed for the year by December. You can report your hours:
  • Online – Use the FSSA Benefits Portal on your phone or desktop computer.
  • By phone with MDwise – Call MDwise customer service at 1-800-356-1204, or 317-630-2831 in the Indianapolis area to report hours.

You can also find a Gateway to Work partner on the HIP website at www.HIP.in.gov (click on “Gateway to Work”) who may be able to help you.

MDwise will send you your Gateway to Work status on each monthly POWER Account statement. This will help you keep track of your progress every month throughout the year.

At the end of the year, a review will determine whether you have met your requirements. If you do not log or complete the required number of hours, you may lose your HIP benefits for the following year. Your HIP benefits will be suspended until you meet the requirements for Gateway to Work.


How to Find Gateway to Work Opportunities


General information about Gateway to Work can be found at www.HIP.in.gov (click on “Gateway to Work”). The website includes:
  • Link to the FSSA Benefits Portal to report your hours.
  • General information about Gateway to Work.
  • An online assessment to help you find what Gateway to Work activity might be right for you and where to start.
  • A list of places where you can work or volunteer.

MDwise can also provide resources for participation in Gateway to Work.


Understanding the Gateway to Work Progress Statement Included with the Monthly POWER Account Statement


MDwise will send your Gateway to Work status and progress on each monthly POWER Account statement. This will help you keep track of your progress.

Your POWER Account statement will show you how many activity hours are required each month. You will see a “Yes” or “No” marked on the months you have completed or not completed Gateway to Work. You will see “Yes” on months your Gateway to Work status is “Exempt” or “Reporting Met.” Months you are not in HIP will also be marked as “Yes.”


Gateway to Work Member Assistance Planning


Many resources are available to help members participate in the Gateway to Work program. You can take an online assessment at www.HIP.in.gov (click on “Gateway to Work”) to help you find activities you can do for Gateway to Work. You can also call MDwise to take the assessment over the phone. If you need more help, we can do a longer assessment over the phone. This will help find any problems you might have to meet your Gateway to Work activity hours. We can talk about your interests and skills and develop a plan for you to be successful with Gateway to Work.


Contact information for members who have issues reporting hours or questions about the Gateway to Work program


For questions about the program or issues reporting hours, contact MDwise customer service at 1-800-356-1204, or 317-630-2831 in the Indianapolis area.


HELPlink


phone-icon.pngHELPlink is a MDwise program that connects members to various organizations in their community. These organizations can help with housing, utilities, job placement and more. HELPlink is available to all members. It is a free resource that can help you overcome the obstacles of daily life, and help you on your pathway to success.


WORKwise


phone-icon.pngWORKwise is a free program for MDwise members. WORKwise connects members to work and education resources. WORKwise Success Guides help members build resumes, prepare for interviews, access educational opportunities and more. Success Guides also provide training, clinics and other tailored opportunities. These tools help prepare members to take steps toward their personal success. Participating in WORKwise helps HIP members fulfill Gateway to Work requirements.

Back to top