inside_header_photo_2

OPEN ENROLLMENT PERIOD

When you enroll with a health plan, you will remain enrolled in your chosen health plan for a one-year period so long as you remain eligible.  If your program has an open enrollment period, that means you have the opportunity once per year, or with "just cause", to change to a different health plan.   You can only change your health plan during an open enrollment period.

Open Enrollment Periods:

  • Anytime during your first 90 days with a new health plan
  • Annually during your open enrollment period

"Just Cause" Reasons:

You may have concerns over the quality of care being provided by your health plan.  If you have a complaint against the 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 file a written complaint with the State.  The State will review your complaint and may determine that you have "just cause" to change your health plan.

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

  • Receiving poor quality of care
  • Failure to provide covered services
  • Failure to comply with established standards of medical care administration
  • Significant language or cultural barriers
  • Corrective action levied against the health plan
  • Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence
  • A determination that another health plan's formulary is more consistent with a new member's existing health care needs
  • Lack of access to medically necessary services
  • A service is not covered 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 health plan'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 health care provider disenrolls from the member's health plan and re-enrolls with another health plan
  • Other circumstances the State determines to be 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 to provide covered services
  • Failure 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 health plan
  • Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence
  • A determination that another health plan's formulary is more consistent with a new member's existing health care needs
  • Other circumstances the State determines to be poor quality of health care coverage