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What Is Covered by Hoosier Healthwise?

This is a general description of the benefits and services available in the Hoosier Healthwise program. Please remember that your health plan may offer additional services. The benefits covered by Hoosier Healthwise include preventive care (like well-baby and well-child care and regular check-ups) and mental health and substance abuse treatment.  Hoosier Healthwise also has benefits for children with special health care needs like asthma or diabetes.

Note: There are some benefit limits for Hoosier Healthwise Package C members.

 

Benefit

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

May have a  $.50-$3.00 co-payment

Yes

$3 co-payment for generic, compound, and sole-source drugs.

$10 co-payment for brand-name drugs.

Over-the-Counter Drugs

Yes

Over-the-counter drugs are not covered by Package C.

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.

Dental Care

Yes

Yes

Vision Care

Yes

Yes

Therapies

Yes

Yes

Hospice Care

Yes

Not Covered

Transportation

Yes

May have a  $.50-$3.00 co-payment

Ambulance transportation for emergencies and between medical facilities.

$10 co-payment for ambulance transportation.

Family Planning Services

Yes

Yes

Nurse Practitioner Services

Yes

Yes

Nurse Midwife Services

Yes

Yes

Foot Care

Yes

Routine foot care services are not covered.

Surgical procedures, lab or x-ray services, and hospital stays involving the foot are covered.

Chiropractors

Yes

Yes

 

If you need to know if a specific procedure or service is covered, ask your doctor or call your health plan.  Some specialized services require that you see or call your doctor before you receive them, which is also called a referral.  See the list below to see services you can get without calling the doctor first:

Covered Services Not in Need of the Doctor's Referral.

  • Dental care
  • Podiatrist care (foot care)
  • Chiropractic care
  • Eye care (except surgery)
  • Mental health services
  • Substance abuse services
  • Transportation service

If you need any other special service or would like to see another type of medical professional, you do need to talk with your doctor to get a referral.  Some services will require your doctor (or other special provider) to request a Prior Authorization(PA) before the service can be delivered.  It is up to the provider to request the PA.