What Benefits Are Covered?
This is a general description of the benefits and services available in the Hoosier Healthwise program. Please keep in mind that a MCO Hoosier Healthwise health plan can offer additional services.
Covered Health Benefits - Children are not "little adults." That's why Hoosier Healthwise offers benefits to meet the health care needs of children of all ages, not just adults. This is important because whether you have a baby, a child, an adolescent, or a teen-ager, your children will have different health care needs at different stages of childhood. The benefits covered by Hoosier Healthwise include primary and preventive care (like well-baby and well-child care and regular check-ups) and mental health and substance abuse treatment. It also has benefits for children with special health care needs like asthma or diabetes. Providing benefits to meet the needs of children helps to keep them healthy and ready to learn in school.
List of Benefits Covered under Hoosier Healthwise
Note: There are some benefits limits for Hoosier Healthwise Package C members.
|
Benefits |
Package A |
Package C |
|---|---|---|
|
Hospital Care |
Yes |
Yes |
|
Doctor Visits |
Yes |
Yes |
|
Check ups |
Yes |
Yes |
|
Well-child Visits |
Yes |
Yes |
|
Clinic Services |
Yes |
Yes |
|
Prescription Drugs |
Yes |
Yes
There is a $3 co-payment for generic, compound and sole-source drugs. There is a $10 co-payment for brand name drugs. |
|
Over-the-counter Drugs |
Yes |
Over-the-counter drugs are not covered by Package C, except for Insulin. |
|
Lab and X-ray Services |
Yes |
Yes |
|
Mental Health Care |
Yes |
Yes |
|
Substance Abuse Services |
Yes |
Yes |
|
Medical Supplies and Equipment |
Yes |
Yes |
|
Home Health Care |
Yes |
Yes |
|
Nursing Facility Services |
Yes |
Nursing facility services are not covered by Package C. |
|
Yes |
Yes | |
|
Vision Care |
Yes |
Yes |
|
Therapies |
Yes |
Yes |
|
Hospice Care |
Yes |
Yes |
|
Transportation |
Yes |
Package C covers ambulance transportation for emergencies and between medical facilities.
There is a $10 co-payment for ambulance transportation. |
|
Family Planning Services |
Yes |
Yes |
|
Nurse Practitioner Services |
Yes |
Yes |
|
Nurse Midwife Services |
Yes |
Yes |
|
Foot Care |
Yes |
Package C covers surgical procedures, lab or x-ray services, and hospital stays involving the foot. |
|
Chiropractors |
Yes |
Yes |
If you need to know if a specific procedure or service is covered, ask your PMP or other provider from whom you'd get the service.
You must see or call your doctor before you get any services other than those listed below:
Covered Services Not Needing the Doctor's OK - also called Self-Referral
- Dental Care
- Podiatrist Care (foot care)
- Chiropractic Care
- Eye Care (except surgery)
- Mental health services
- Substance abuse services
- Transportation services
Preventive Care - Many services are meant to keep you or your child from getting sick. It is up to you to use these services. As soon as you join Hoosier Healthwise, call your PMP for an appointment for each family member in the program. This is important because your personal doctor (PMP) can:
- Get to know your family's health needs
- Show you what you can do to keep your family healthy
- Check for early signs of health problems
Prenatal Care - Early and regular prenatal care is important while you are expecting. It doesn't matter if this is your first pregnancy or not, regular prenatal care is important. Each pregnancy is different. Call your doctor to schedule your first prenatal visit as soon as possible. You should have your first prenatal care visit with your doctor during the first three months of your pregnancy. An average pregnancy can require 12 to 14 prenatal care visits. Talk to your doctor about prenatal care for you and your baby.
Specialty Care - Your personal doctor (PMP) will be able to take care of most of your medical problems. If your personal doctor thinks you needs to see a specialist, he or she will send you to one. Your personal doctor (PMP) is very good at finding out what medical problems you have and will know what kind of doctor is the right kind to treat your problem.
Emergency Care - In the case of an emergency, call your personal doctor (PMP) first. If his or her office is closed, use the number your doctor gave you for after office hours. Your doctor, or someone who works with your doctor, will tell you what to do. If calling your doctor would cause a delay in treatment that may result in lasting injury or death, go to the emergency room and call your doctor from there. If it is a true emergency, the hospital will treat you and call your doctor later. Some examples of a true emergency are: broken bones, bad bleeding that can't be stopped, or your child swallowed something poisonous. A true emergency is NOT something like a common cold, diaper rash, skin bumps, or a mild common headache.
