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OPEN ENROLLMENT PERIOD

With the Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect programs, you must remain enrolled in your chosen health plan for a one-year period so long as you remain eligible. This gives your health plan an opportunity to improve the care it provides. You may only change your health plan during certain times of the year or if your change reason falls under the conditions outlined below:

Open Enrollment Periods:

  • Anytime during your first 90 days with a new health plan.
  • Annually during your open enrollment period.
  • Anytime you file a grievance with your health plan and the State finds that you have a good reason to change health plans. Another name for good reason to change health plans is "just cause." This is when you have concerns over the quality of care being provided by your health plan.  You must first contact your health plan so they can attempt to resolve your concern.  If you are still unhappy after contacting your health plan, you can call the Hoosier Healthwise Helpline at 1-800-889-9949, and they will review your request.

"Just Cause" Reasons:

The following are the "just cause" reasons for switching health plans during the year for the Hoosier Healthwise and Hoosier Care Connect programs:

  • Receiving poor quality of care;
  • Failure of the Contractor to provide covered services;
  • Failure of the Contractor to comply with established standards of medical care administration;
  • Significant language or cultural barriers;
  • Corrective action levied against the Contractor by FSSA;
  • Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence;
  • A determination that another MCE's formulary is more consistent with a new member's existing health care needs;
  • Lack of access to medically necessary services covered under the Contractor's contract with the State;
  • A service is not covered by the Contractor for moral or religious objections;
  • Related services are required to be performed at the same time and not all related services are available within the Contractor's network, and the member's provider determines that receiving the services separately will subject the member to unnecessary risk;
  • Lack of access to providers experienced in dealing with the member's healthcare needs;
  • The member's primary healthcare provider disenrolls from the member's current MCE and re-enrolls with another Hoosier Care Connect MCE; or
  • Other circumstances determined by FSSA or its designee to constitute poor quality of health care coverage.

The following are the "just cause" reasons for switching health plans during the year for the Healthy Indiana Plan program:

  • Receiving poor quality care.
  • Failure of the insurer to provide covered services.
  • Failure of the insurer to comply with established standards of medical care administration.
  • Lack of access to providers experienced in dealing with the member's health care needs.
  • Significant language or cultural barriers.
  • Corrective action levied against the insurer by the office.
  • Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence.
  • A determination that another insurer's formulary is more consistent with a new member's existing health care needs.
  • Other circumstances determined by the office or its designee to constitute poor quality of health care coverage.