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Benefits and Services | Hoosier Healthwise

Services for mental health, behavior problems and alcohol and drug abuse.

Behavioral Health Services

DentaQuest provides your dental services under Hoosier Healthwise. Dental care is very important for your health and well-being. You need to have regular check-ups every six months at your dentist's office. Below are the dental services that are covered under Hoosier Healthwise. For more information about taking care of your teeth, please read our brochure (English) | our brochure (Spanish) | our brochure (Burmese).

Dental Benefits Covered

Package A Adult

• Two exams and one cleaning per year*
• Bite-wing X-rays once every 12 months, one complete set of X-rays every 3 years
• Restorations such as fillings and stainless steel crowns
• Periodontal care includes deep cleanings and surgical treatment for gum disease
• Partials, full dentures, immediate dentures, and repairs to partials and dentures
• Extractions

Package A Child

• Two exams and cleanings per year*
• Fluoride varnish
• Sealants
• Bite-wing X-rays once every 12 months, one complete set of X-rays every 3 years
• Restorations such as fillings and stainless steel crowns
• Endodontic procedures such as root canals
• Periodontal care includes deep cleanings and surgical treatment for gum disease. Begin dental exams twice per year after first tooth or no later than first birthday.*
• Partials, full dentures, and repairs to partials and dentures
• Extractions
• Sedation and nitrous oxide if medically necessary

Package C CHIP

• Two exams and cleanings per year*
• Fluoride varnish
• Sealants
• Bite-wing X-rays once every 12 months, one complete set of X-rays every 3 years
• Restorations such as fillings and stainless steel crowns
• Endodontic procedures such as root canals
• Periodontal care includes deep cleanings and surgical treatment for gum disease. Begin dental exams twice per year after first tooth or no later than first birthday.*
• Partials, full dentures, and repairs to partials and dentures
• Extractions
• Sedation and nitrous oxide if medically necessary

Find a Dentist

To find a participating dentist with DentaQuest, you can use the Find A Dentist search or call 844-231-8310, 8 a.m. to 8 p.m. Monday through Friday. You may also call MDwise customer service at 1-800-356-1204, Monday through Friday, 8 a.m. to 8 p.m.

Find A Dentist

Emergency Dental Care

If you experience dental pain, call your dentist right away. Your dentist will arrange to see you as soon as possible.

Dental Questions?

For any questions regarding eligibility, finding a dentist, benefits or other questions, call MDwise at 1-800-356-1204, Monday through Friday, 8 a.m. to 8 p.m. TTY/TTD users should call 1-800-743-3333.

Drug Lookup & Drug Interactions:

Drug Interaction Checker

Drug Side Effects

Package A

How the Prescription Benefit Works for Package

When you need medicine or over-the-counter items, your doctor will write a prescription. You can take that prescription to any MDwise participating pharmacy.

Medically needed drugs and some over-the-counter or OTC items are covered for Package A members. The drugs must be approved by the Food and Drug Administration (FDA). A network doctor must prescribe these drugs and OTC items.

You can go to any MDwise network pharmacy. You may search pharmacies and drug prices by selecting the Find a Pharmacy/Drug Price Check link. If you have pharmacy questions or problems, please call 1-800-356-1204.

Copays for Package A

Package A members have no copays for covered drugs when filled at a network pharmacy. 

Hoosier Healthwise gives your health care provider a tool called a formulary.

This helps him or her prescribe drugs for you. A formulary is a list of some of the brand and generic medicines covered by MDwise Hoosier Healthwise. MDwise Hoosier Healthwise members can call 1-844-336-2677 to ask about medicines that are covered. If you have Internet access, you can go to the Find a Drug page. This drug list also tells you some of the over-the-counter medicine and vitamins that are covered.

Home delivery of your maintenance medicines are also available. Maintenance medicines are taken regularly for chronic or long-term conditions. How to start home delivery or mail order.

Package C

When you need medicine or over-the-counter items, your doctor will write a prescription. You can take that prescription to the pharmacy.

Drugs and some over-the-counter (OTC) items are covered for Package C members. The drugs must be approved by the Food and Drug Administration (FDA). A network doctor must prescribe these drugs and OTC items.

You can go to any MDwise network pharmacy. You may search pharmacies and drug prices by selecting the Find a Pharmacy/Drug Price Check link. If you have pharmacy questions or problems, please call 1-800-356-1204.

Copays for Package C

There are copays for Package C member prescription medicines. The copays will be up to $10 when filled at a network pharmacy.

Hoosier Healthwise gives your child’s health care provider a tool called a formulary.

This helps him or her prescribe drugs for you. A formulary is a list of some of the brand and generic medicines covered by Hoosier Healthwise. MDwise Hoosier Healthwise members can call 1-844-336-2677 to ask about medicines that are covered.

If you have Internet access, you can go to the Find a Drug page. This drug list also tells you some of the over-the-counter medicine and vitamins that are covered.

Home delivery of your maintenance medicines are also available. Maintenance medicines are taken regularly for chronic or long-term conditions. How to start home delivery or mail order.

HHW Package C (CHIP - Children’s Health Insurance Program) *Members are required to pay applicable copayments at the pharmacy when services are provided.	Generics Compounds Sole Source Drugs Multisource Brand Preferred Drugs	$3 copay
	All Other Brand Drugs	$10 copay
	Preventative Drugs (Essential Health Benefit)	$0 copay

Do you need your prescription refilled?

Below are places we are partnered with where you can get your prescription refilled online.
 

	Birdi, Inc. (Home Delivery): Order refills online
	Walgreens: Order refills online
	Walmart: Order refills online
	Kroger: Order refills online
	Meijer: Order refills online

How Do I Set Up New Prescriptions with Birdi, Inc.?

Option #1: Your Doctor Sends Your Prescription

Your doctor sends your prescription directly to MedImpact Direct Mail. The prescription is sent electronically or by fax to 1-888-783-1773. Birdi can only accept electronic or faxed prescriptions from your doctor. They will automatically fill and ship most new prescriptions they get from your doctor except for controlled substances.

Option #2: Sign into Website

Sign into their website at www.medimpact.com to request a new prescription or transfer from a retail pharmacy. Choose “Transfer/Request Prescriptions” at the top of “My Prescriptions -> Prescription List”” page and follow instructions.

Option #3: Mail Your Prescription

Fill out the order form or sign in to www.medimpact.com. Visit Documents -> Medication Order Form. Send the form with your prescription(s) to:

Birdi, Inc.
PO Box 51580
Phoenix, AZ 85076-1580

Questions?

If you have questions, please call Birdi toll-free at 1-855-873-8739 (TTY dial 711).

Birdi customer service hours are:

Monday-Friday 8:00 am – 8:00 pm Eastern Time
Saturday 9:00 am – 4:00 pm Eastern Time

Or email them at customerservice@birdirx.com. Email messages are replied to within two business days. For security and privacy, please do not include personal health information.

Eye care benefits are available for members enrolled in Hoosier Healthwise.

Eye Exams

• One eye exam per year for members under 21 years old.
• One eye exam every two years for members over 21 years old.
• Additional examinations must be medically necessary.

Eyeglasses (including frames and lenses)

• One pair of eyeglasses a year for members under 21 years old.
• One pair of eyeglasses every five years for members 21 years and over.
• Repairs or replacements of eyeglasses for reasons that are beyond your control. Examples include fire, theft or a car accident.

Getting Eye Care Services

To get eye care services, you can call an eye doctor (either an optometrist or ophthalmologist). The eye care doctor must be contracted with the state of Indiana. When making appointments, be sure to ask if the office is contracted with the state of Indiana. You can search for eye care providers by visiting our Find a Doctor page. You can also call MDwise customer service at 1-800-356-1204 and we can help.

There are some health services that are not covered by the Hoosier Healthwise program. For a complete list of these services, see the Hoosier Healthwise section of the member handbook. There are some network, service or benefit restrictions, see the Hoosier Healthwise section of the member handbook for more information.

Hoosier Healthwise Member Handbook (English) | Hoosier Healthwise Member Handbook (Spanish)

Hoosier Healthwise Covered Medical Services

MDwise wants to help you stay healthy. That is why we cover preventive care as well as sick care. If there are changes to your benefits, we will let you know by mail. If you have any questions about your benefits, please talk to your doctor or call MDwise customer service.

Preventive Care

Getting regular preventive care is the key to better health. You get preventive care when you go to the doctor for check-ups and other well care. MDwise covers preventive care because it keeps you healthy and checks for problems before they become serious. Examples include:

• Check-ups and shots for adults and children.
• Care for pregnant women.
• Well-baby care.
• Physical exams.
• Mammograms and Pap smears.

Necessary Care

Care must be “medically necessary.” This means it is:

• Needed to diagnose or treat you.
• Proper based on current medical standards.
• Not more than what is needed.

Prior Authorization

Some services need approval from MDwise before you get them. This is called prior authorization. If your doctor does not get prior authorization when it is needed, MDwise will not pay for the services. Prior authorization decisions are based only on the appropriateness of care and services. These decisions are also based on whether or not you have coverage. Doctors and staff who make prior authorization decisions do not get incentives or rewards for making these decisions. They do not get payment for deciding to deny a service or for making decisions that may make it harder to get care and services.

Your health care provider will call the prior authorization department for you to ask questions about prior authorization requests or to request a prior authorization. You can also call the prior authorization department with questions about prior authorization requests from your health care provider and in general. You can reach them via a toll-free number at 1-800-788-2949 Monday–Friday from 8 a.m. to 5 p.m. This does not include holidays. The language line can assist non-English speaking callers. If you call the toll-free number after hours, on a holiday or on a weekend, you can leave a voicemail and the department will call you back the next business day.

Services From Other Providers for Hoosier Healthwise Members

Sometimes, you may need to see a provider other than your regular doctor.

Seeing a Specialist

A specialist is a doctor who treats one part of the body, like the heart, skin or bones. Your regular doctor will write you a referral if you need to see a specialist.

Self-Referral Services

MDwise covers these services. Your doctor can help you get these services, but you do not have to go through your doctor to get them. You can go to any Hoosier Healthwise provider to get these services. Self-referral providers must get an okay from MDwise before giving you some services.

Remember, your doctor can best take care of you if you talk to the doctor before getting any kind of health care.

The following services are “self-referral” services within the MDwise network:

• Eye care.
• Foot care.
• Mental health and substance abuse services.
• Chiropractor services.
• Emergency services.
• Urgent care services.
• HIV case management.
• Family planning (If your family planning provider prescribes birth control pills, you can get a 90 day supply).
• Immunizations (for example, at health department, school).
• Diabetes self-management training (if given by a self-referral provider).
• Services from a psychiatrist.
• School-based health services. (Immunizations, sick visit)
  • School based health services help meet the needs of a student or family member. Services can include mental or behavioral services, healthy habit education plus injury prevention. Talk with your child’s school or call MDwise Customer Service at 1-800-356-1204.

Services Outside MDwise

For most services you need to go to a MDwise provider. For some services, you can go to any Hoosier Healthwise provider who is registered with IHCP. If you get these services, please let your doctor know. This helps them take care of you. You do not have to get all of your maternity services from MDwise.

For questions, call customer service or contact your doctor.

• Services for a student’s individualized education program (IEP).
• Medicaid Rehabilitation Option (MRO) services.

Services Not Covered By MDwise

The following services are not covered by MDwise under Package A:

• Services provided in a nursing home (long-term facility).
• Services provided in an intermediate care facility
for individuals with intellectual disabilities (ICF/IID).
• Hospice care.
• Services under the home and community-based services (HCBS) waiver.
• Psychiatric treatment in a State hospital.
• Psychiatric Residential Treatment Facility (PRTF) services.

If you need these services, there may be programs outside of Hoosier Healthwise that can help cover these services. To learn more, call Hoosier Healthwise at 1-800-889-9949.

The following services are not covered by MDwise under Package C:

• Services provided in a nursing home (long-term facility).
• Services provided in a nursing home (short term facility).
• Services provided in an intermediate care facility for the mentally retarded (ICF/MR).
• Hospice care.
• Services under the home and community-based services (HCBS) waiver.

What is MDwise HELPlink?

Find the help you need close to you.
Search for programs to help with food, education,
housing, jobs and other things you may need.

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OPPORTUNITYlink

The Right Choices Program is an MDwise care management program for people who need help using their health care benefits. People in the Right Choices Program can be sure to get good health care because each person has a team to help manage his or her health care.

Your Right Choices Program team includes:

• Your MDwise doctor (also called a primary medical provider or PMP).
• One pharmacy.
• One hospital.
• An MDwise care manager.

The team will help decide when, where and how you will get medical care. Your MDwise doctor will manage your care and give you referrals for other services if needed. You will get better health care because your doctor knows your medical history.

For more information about the Right Choices Program, see the MDwise Right Choices Program Brochure (English).

MDwise Disease Management Program

MDwise wants to help all members stay as healthy as possible. As a member with a chronic condition like diabetes or depression, you are automatically enrolled in this program.

The choices you make every day are very important to manage your condition. MDwise INcontrol programs can help you. MDwise Care Management staff will answer questions you have. They will help you:

• Learn about your condition.
• Manage your medicines.
• Learn the best ways to work with your doctor.
• Follow your doctor’s advice.
• Learn about testing that you should have.
• Take steps to keep your condition from getting worse.
• Get the supplies and services you need.

You will get helpful information related to your disease sent to you in the mail several times a year. We will talk to your doctor about your condition and how you are doing.

The more you know about your condition, the better you can control it. Be sure to see your doctor on a regular basis. Talk with your doctor about all the questions you have. This will help to keep you from having to go to the hospital or Emergency Room.

If you have any questions about the program and how to use these services, please call MDwise customer service at 1-800-356-1204.

Hearing and Speech Impaired Members

Call the Relay Indiana Service at 1-800-743-3333. You can also dial “711”. This number can be used anywhere in Indiana.

Ask them to connect you to MDwise: 1-800-356-1204.

If you do not want to be a part of the program, you may call 1-800-356-1204 to opt out of the program.

Additional Resources

For additional resources about chronic conditions, please view our INcontrol materials.

SNAP (Supplemental Nutrition Assistance Program)

SNAP (food assistance) or what was known as food stamps, helps low-income people and families buy the food needed to stay healthy. Benefits are loaded onto an ATM like card and can be used at most stores. You can now order food online and have it delivered through Amazon, Walmart and ALDI (fees may apply). This can be used on foods such as breads and cereal, fruits and veggies, meats, fish and poultry, dairy products or seeds/plants to grow your own produce. SNAP benefits are given monthly and are based on household size and income. To apply, visit your local Division of Family Resource office or visit the FSSA Benefits page.

Protect Your Benefits
DFR | Protect your Hoosier Works Benefit Card

MDwise covers transportation to doctor, dental or clinic appointments for Hoosier Healthwise. If you want to schedule transportation, call 1-800-356-1204 and choose the transportation option. You should call MDwise to arrange a ride the same day you call for your appointment. If you cancel or change your visit, call MDwise right away to cancel or change your ride.

If available in your area, MDwise may give you a bus pass for your trip to the doctor. You can also request Gas Mileage Reimbursement. For urgent care your PMP or PMP office staff must call to arrange for same day transportation (urgent care only).

RIDEwise flyer (English)
RIDEwise flyer (Spanish)
RIDEwise flyer (Burmese)

 

Gas Mileage Reimbursement:

You, a friend or even a relative can drive to a doctor, dentist or clinic and be paid back. Just call 1-800-356-1204 and choose the transportation option. Let the person who answers the phone know you want to use gas mileage reimbursement. If you don’t schedule your trip and get it approved, your friend or relative may not get paid back for the trip.

Your driver must have current insurance on their car and a valid driver’s license if they want to transport you. MDwise will send you a form to fill out about how many miles you drove to and from the appointment and you will also need to get the doctor’s signature on the form.

To Schedule a Ride:

You should call MDwise to set up a ride the same day you call for your appointment. You must call two days before your appointment to get a ride. For example, if your visit is on Monday, you must call by the previous Thursday at the latest. Weekend days and holidays do not count. If you need an urgent trip, let us know.

Schedule your appointment with your doctor or dentist before you call to schedule a ride.

• Have your member ID card ready when you call to schedule a ride. You will also need to know:
  • Your address and phone number.
  • The date and time of the visit and the time you think it will end.
  • The name, address and phone number of the doctor, dentist or clinic.
• Call MDwise customer service to reserve your ride. Listen carefully and pick the transportation option.

You must call between 8:00 a.m. and 8:00 p.m., Eastern time, Monday through Friday. MDwise does not cover trips to the pharmacy.

You should only take an ambulance when it is a true emergency. See the member handbook (English) | member handbook (Spanish) for examples of true emergencies. If you think your problem could cause lasting harm or loss of life, call 911. Package C members can get ambulance transportation for true emergencies only, at a reduced price.

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