OPEN ENROLLMENT PERIOD
The Hoosier Healthwise program has an open enrollment
period. Open Enrollment means that you will remain enrolled
in your chosen health plan for a one-year period so long as you
remain eligible for Hoosier Healthwise. This gives your health plan
an opportunity to improve the care it provides. With open
enrollment, you can only change your health plan at certain times
during the year.
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:
- Lack of access to medically necessary services covered under
the MCO's contract with the State;
- The MCO does not, for moral or religious objections, cover the
service the enrollee seeks;
- The enrollee needs related services to be performed at the same
time; not all related services are available within the MCO's
network; and the enrollee's primary care provider or another
provider determines that receiving the services separately would
subject the enrollee to unnecessary risk;
- Lack of access to providers experienced in dealing with the
enrollee's health care needs;
- Poor quality of care. Poor quality of care includes failure to
comply with established standards of medical care administration
and significant language or cultural barriers.