How Do I Get Care For My Family?
Hoosier Healthwise is Indiana's health care program for children, pregnant women, and low-income working families. There are some important things to know to get care.
Primary care doctor - Because it is so important for your family to get the care they need when they need it the most, Hoosier Healthwise makes sure that every member has a primary care doctor, known as a PMP (primary medical physician). The PMP is responsible for making sure that your child gets the care they need to grow up healthy during each stage of your child's life. Your child's (or your) PMP also coordinates the care that is provided when there is more than one doctor involved in treatment.
Choosing a PMP - Families must choose a primary care doctor within 30 days of signing up for the program. If you do not, your family will be assigned to a doctor. Every member who is in the program must have a primary care doctor. When a family applies for Hoosier Healthwise, you will get a list of doctors in your area to choose from. When you have chosen, you MUST then tell a Benefit Advocate in order to finish the enrollment process. A Benefit Advocate is available either where you completed your application or by calling 1-800-889-9949 (free call).
Before you choose a doctor, ask yourself:
- "What kind of doctor is best for my family?" If you or a family member is pregnant, you will need to choose a doctor that treats pregnancy and delivers babies. Would you prefer your children to be cared for by a doctor who specializes in children only, or would you prefer all family members to go to the same doctor, a family doctor?
- "How will I get to that doctor?" Make sure the office or clinic you choose is somewhere you can get to easily.
How the health care is delivered - In Hoosier Healthwise, health care is delivered through two types of "health plans." When you pick a doctor for your child (or yourself), your child will be in the same health plan as the doctor. You will need to decide which health plan is best for your child.
- In the PrimeStep health plan (sometimes called PCCM):
- Your personal doctor (PMP) must okay some kinds of care before you schedule it for your child (or yourself).
- You may have to make appointments yourself.
- In a Managed Care Organization (MCO) health plan:
- You must get care only from providers in the MCO network. A "network" is a group of doctors and other providers of care like the hospital, pharmacy, transportation services and so on.
- Some extra services are provided.
Hoosier Health Card - Each Hoosier Healthwise member will be sent a letter to tell them when they are eligible for the program and the name and address of their doctor. You will also receive a Hoosier Health Card. You need to bring your card with you to each doctor's appointment and for other services when you need health care services.
The MCO health plans may also have a member card with important information (such as your doctor's name and phone number, etc.). Please carry your Hoosier Health Card with your MCO health card to improve delivery of services.
Member Handbook - Each Hoosier Healthwise health plan has a member handbook that will be mailed to you after you are eligible for Hoosier Healthwise. The Member Handbook contains good information about what services are provided and important things for you to know. For example, in each member handbook there is information about who to call and what to do if you have a problem or complaint about health care services.
Benefits and Services - A general description of the services available in the Hoosier Healthwise program. Please keep in mind that a MCO Hoosier Healthwise health plan can offer additional services.
See also Other Important Information
