MDwise
Benefits and Services | HIP

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

View Behavioral Health Services

DentaQuest provides your dental services under Healthy Indiana Plan. 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 Healthy Indiana Plan. For more information about taking care of your teeth, please read our brochure (English) | our brochure (Spanish) | our brochure (Burmese).

Dental Benefits Covered

HIP Plus

• Oral exams every six months
• Emergency oral exams
• Dental x-rays
  - Complete set once every 5 years
  - Bite-wing x-rays once every 12 months
• Teeth cleaning once every six months
• Minor restorative services like fillings
• Major restorative services like crowns

HIP Basic (members 19-20 years old)

• Oral exams every six months*
• Emergency oral exams
• Dental x-rays
  - complete set every three years
  - bite-wing x-rays once every 12 months
• Teeth cleaning once every six months*

HIP State Basic

• Oral exams every six months
• Emergency oral exams
• Dental x-rays
• Complete set once every three years
• Bite-wing x-rays once every 12 months
• Teeth cleaning once every six months for members under 21 years old
• Teeth cleaning once per year for members 21 years old and older
• Minor restorative services such as fillings
• Dentures and denture repairs
• Extractions

HIP State Plus

• Oral exams every six months
• Emergency oral exams
• Dental x-rays
• Complete set once every three years
• Bite-wing x-rays once every 12 months
• Teeth cleaning once every six months for members under 21 years old
• Teeth cleaning once per year for members 21 years old and older
• Minor restorative services such as fillings
• Dentures and denture repairs
• Extractions

All HIP Pregnancy Plans

• Oral exams every six months*
• Emergency oral exams
• Dental x-rays
  - complete set once every three years
  - bite-wing x-rays once every 12 months
• Teeth cleaning once every six months*
• Fillings (limit 1 filling per tooth per year)
• Extractions, Surgical Removal of Erupted or Impacted Tooth (No limit)
• Dentures and denture repairs

*Must be at least six months apart.

What's Not Covered?

Your dentist can tell you the full list of services covered by the Healthy Indiana Plan.

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 if you need assistance.

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.

Lookup drug-drug interactions:

Drug Interaction Checker

Drug Side Effects

Medicines for MDwise HIP members are covered. You can go to any pharmacy within the MDwise pharmacy network. If you have pharmacy questions or problems, please call 1-844-336-2677.

How the Prescription Benefit Works

When you need medicine or over-the-counter items, your doctor will write a prescription. You can take that prescription to the network pharmacy of your choice. You may search pharmacies by selecting the find a pharmacy/price check link below for your plan.

HIP Plus members have no copays for covered drugs. HIP Basic and HIP State Plan Basic members have copays for covered drugs up to $8. There is no copay for family planning and maternity services. You may look at the list of covered drugs and their copay by selecting the find a drug link below for your plan.

Some over-the-counter medicines or vitamins are covered under HIP. To see which ones are covered select the find a drug link below for your plan.

HIP Plans	Preventative Drugs (Essential Health Benefit)	Preferred Drugs (PDL)	Non-Preferred Drugs (PDL)	Neutral Generic Drugs (non-PDL)	Neutral Brand Drugs (non-PDL)
HIP Plus Copay	$0	$0	$0	$0	$0
HIP Basic Copay	$0	$4	$8	$4	$8
HIP State Plan Basic Copay	$0	$4	$8	$4	$8
*Members are required to pay applicable copayments at the pharmacy when services are provided.

Some over-the-counter medicines or vitamins are covered under HIP. To see which ones are covered select the find a drug link below for your plan.

Prescription Medicine

The Healthy Indiana Plan covers necessary medicines. Your doctor must prescribe these medicines. It must be a medicine approved by the Food and Drug Administration (FDA).

The Healthy Indiana Plan gives your doctor a tool called a formulary. This helps him or her prescribe drugs for you. A formulary is a list of the brand and generic medicines covered by the Healthy Indiana Plan. MDwise Healthy Indiana Plan members can call 1-844-336-2677 to ask about medicines 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.

Statewide Uniform Preferred Drug List (SUPDL)

Effective July 5, 2023, MDwise will move to the Statewide Uniform Preferred Drug List (SUPDL). This means that MDwise will cover the same preferred and nonpreferred drugs and maintain the same clinical criteria requirements as other IN Medicaid providers.

• The SUPDL may be viewed on the FFS website: https://inm-providerportal.optum.com/providerportal/faces/PreLogin.jsp. From the homepage, click Preferred Drug List on the right.
• Prior authorization criteria for drugs on the SUPDL may be viewed on the FFS website: https://inm-providerportal.optum.com/providerportal/faces/PreLogin.jsp. From the homepage, click PA Criteria and Administrative Forms on the right. Under the heading Pharmacy Forms, click on Pharmacy Prior Authorization Criteria and Forms. 

Pharmacy Resources for HIP Plus members

Find a pharmacy/price check for HIP Plus members

Find a drug HIP Plus members

Pharmacy Resources for HIP Basic members

Find a pharmacy/price check HIP Basic members

Find a drug HIP Basic members

Pharmacy Resources for HIP State Plan members

Find a pharmacy/price check HIP State Plan members

Find a drug HIP State Plan members

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 the 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. 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 in the following plans:

• HIP Plus
• HIP Basic members ages 19 - 20
• HIP State Plan Plus
• HIP State Plan Basic
• All pregnant HIP members

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.

Covered Medical Services for HIP Members

There are some network, health service or benefit restrictions, see pages 19-20 of the Healthy Indiana Plan member handbook for more information.

Member Handbook (English) | Member Handbook (Spanish)

MDwise wants to help you stay healthy. That is why we cover preventive care as well as sick care. We will let you know by mail if there are changes to your benefits. Even if your benefit plan changes, your ID card will still work. The card is good until you are not enrolled with MDwise in the Healthy Indiana Plan. If you have any questions about your benefits, please talk to your doctor or call MDwise customer service.

It is also important to understand your Benefit Year and Eligibility Period (also known as Redetermination Period). Your Benefit Year starts January 1 and ends December 31 each calendar year. Your Eligibility Period (Redetermination Period) is 12 months from when you are approved for coverage. This can be different for each person.

Benefit Year

• IMPORTANT: You must participate in the annual Eligibility (Redetermination) process.
• Your Benefit Year does not change if you leave the HIP program and return during the year.
• Your benefit limits and POWER Account reset every year in January.
• The HIP Health Plan Selection Period is every year from November 1–December 15. During this time, you will have the chance to stay with your current health plan or change your health plan for the next benefit year.
• NOTE: If you like MDwise you do not need to take any action to stay with your current health plan. Your MDwise coverage will automatically continue into the next benefit year. MDwise is committed to serving your health care needs.
• If you want to change your health plan, you can do that during the Health Plan Selection Period that happens every year from November 1–December 15. You will need to contact the enrollment broker at 1-877-438-4479.
• If you get preventive services, your POWER Account payments may be less the next year.

Eligibility (also known as Redetermination) Period:

• You can buy in to HIP Plus during the Eligibility Period.
• Letters for your eligibility will come from the Indiana Family and Social Services Administration (FSSA).

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. In addition, your future POWER Account contributions could be lower if you get any of your preventive care services.

Examples of preventive care include:

• Check-ups and shots.
• Physical exams.
• Mammograms and Pap smears.
• Eye care exams.
• Dental exams.

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. MDwise will not pay for the services if your doctor does not get prior authorization when it is needed. Prior authorization decisions are based on whether the care and services are appropriate. These decisions are also based on whether or not you have coverage.

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 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 HIP 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

The table below outlines the self-referral services for each HIP health plan. You do not need a referral from your doctor to receive these services. You may go out of network for these services unless it states below "in-network only."

	HIP Basic	HIP Plus	HIP State Plan Basic	HIP State Plus	HIP Maternity
Eye care.	not covered for age 21+	X	X	X	X
Dental services (in-network only).	not covered for age 21+	X	X	X	X
Psychiatric services.	X	X	X	X	X
Family planning.	X	X	X	X	X
Emergency services (including dental emergencies).	X	X	X	X	X
Immunization.	X	X	X	X	X
Diabetes self-management (in-network only).	X	X	X	X	X
Behavioral health services (in-network only).	X	X	X	X	X
Urgent care.	X	X	X	X	X
Chiropractic services.	not covered in HIP Basic	X	X	X	X
Podiatry.	not covered in HIP Basic except when medically necessary	not covered in HIP Plus except when medically necessary	X	X	X

Services Outside MDwise

For most services you need to go to a MDwise provider. For some services, you can go to any HIP 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 Healthy Indiana Plan Maternity services from MDwise. For questions, call customer service or contact your doctor.

Services Not Covered

The following services are not covered under the Healthy Indiana Plan:

• Long-term care services.
• Bariatric surgery (not covered for HIP Basic).
• Services provided in an intermediate care facility for individuals with intellectual disabilities (ICF/IID).
• Psychiatric treatment in a State hospital.
• Services under the home and community based services (HCBS) waiver.
• Services that are not medically necessary.
• Dental services (not covered for HIP Basic members 21 and older except for emergency services).
• Conventional or surgical orthodontics, or any treatment of congenitally missing, malpositioned, or super numerary teeth, even if part of a congenital anomaly.
• Vision services (not covered for HIP Basic for members 21 and older).
• Podiatry (not covered for HIP Basic and HIP Plus members unless medically necessary).
• Elective abortions and abortifacients.
• Chiropractic services, except for those services covered under the plan that are within the scope of practice of a chiropractor (Not covered for HIP Basic).
• Drugs excluded from HIP.
• Experimental and investigative services except for cancer related.
• Day care and foster care.
• Personal comfort or convenience items.
• Cosmetic services, procedures, equipment or supplies, and complications directly relating to cosmetic services, treatment or surgery, with the exception of reconstructive services performed to correct a physical functional impairment of any area caused by disease, trauma, congenital anomalies or a previous medically necessary procedure.
• Safety glasses, athletic glasses and sunglasses.
• LASIK and any surgical eye procedures to correct refractive errors.
• Vitamins, with the exception of vitamins included through the pharmacy benefit.
• Wellness benefits other than tobacco cessation.
• Diagnostic testing or treatment in relation to infertility.
• In vitro fertilization.
• Gamete or zygote intrafallopian transfers.
• Artificial insemination.
• Behavioral and Primary Healthcare Coordination (BPHC) Services
• Reversal of voluntary sterilization.
• Gender reassignment surgery.
• Treatment of sexual dysfunction.
• Body piercing.
• Alternative or complementary medicine including, but not limited to, acupuncture, holistic medicine, homeopathy, hypnosis, aroma therapy, reiki therapy, massage therapy and herbal, vitamin or dietary products or therapies.
• Treatment of hyperhidrosis.
• Court-ordered testing or care, unless medically necessary.
• Travel-related expenses including mileage, lodging and meal costs, except when medically related with a prior authorization (PA).
• Missed or canceled appointments for which there is a charge. Note: IHCP providers are not allowed to charge missed or canceled appointment fees.
• Services and supplies provided by, prescribed by, or ordered by immediate family members, such as spouses, caretaker relatives, siblings, inlaws or self.
• Services and supplies for which an enrollee would have no legal obligation to pay in the absence of coverage under the plan.
• Routine foot care not covered in HIP Basic and Plus unless medically necessary.
• Surgical treatment of the feet to correct flat feet, hyperkeratosis, metatarsalgia, subluxation of the foot and tarsalgia.
• Any injury, condition, disease or ailment arising out of the course of employment if benefits are available under any Worker’s Compensation Act or other similar law.
• Examinations for the purpose of research screening

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.

GET HELP

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.
• A 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 Healthy Indiana Plan. 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.

Join the MDwise Member Perks Program!

MDwise provides members with exclusive perks! Find over $4,500 in savings on everything from pizza and the zoo, to movie tickets, oil changes, hotels, and car rentals.

Popular Features Include: 

• Nearby Offers: Use our show & save mobile coupons to quickly access savings on the go
• eTickets On Demand: Save up to 40% with no hidden fees
• Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you
• Monthly Giveaways: Win cash, movie tickets, electronics, and more with out monthly contests

With more than a million redemption locations across 10,000 cities in the United States and Canada, you'll never be far from savings!

REGISTER & LOG IN

SPREAD THE WORD

Download our perks flyer!  SAVEwise flyer (English) | SAVEwise flyer (Spanish)

THREE TIPS TO GET YOU STARTED

1. Mobile Apps: For quick access to savings on the go and to receive proactive Perk Alerts of nearby offers, download our apps
2. Emails: Subscribe to our newsletters and be the first to know about new discounts and giveaways
3. Connect: Register for free giveaways, get the inside scoop, and share your savings stories on Facebook, X (formerly Twitter), or Instagram using #LifeHasPerks

Earn points for a variety of activities, like going to your doctor appointments. Then shop for gift cards with your points. Find out more on MDwiseREWARDS