CMCS Connections

C M C S c o n n e c t i o n s s p e c i a l i n s e r t • 3 r d q u a r t e r 2 0 1 5 Reference Guide for Member Benefit Packages Indiana health coverage programs PACKAGE DESCRIPTION ON WEB INTERCHANGE GENERAL BENEFIT DESCRIPTION CO-PAY/PREMIUM REQUIREMENT MANAGED CARE ASSIGNMENT Package A Standard Plan (HHW) Full coverage of medically necessary services. *Includes dental, eye care and transportation. No monthly premium, some co- pays for Rx, non-emergent ER and transportation required for members not assigned to an MCE. Yes; however, there may be transitional periods where a members is not assigned to an MCE. Pregnancy Package A (HHW) Full coverage of medically necessary services. *Includes dental, eye care and transportation. No. Yes; however, there may be transitional periods where a members is not assigned to an MCE. Package C (CHIP) Coverage of most medical, dental and eye care; emergency transportation only. *Check IHCP manual for full benefit limitations. Monthly premium required, some co-pays for Rx, emergency transportation. Yes. Package E Emergency services only. *Includes OB delivery but not prenatal care. No. No. Package P Presumptive Eligibility (PEPW) Temporary coverage for prenatal services only (includes pregnancy related transportation). No. Yes. Package Family Planning Coverage for family planning services only. *Check IHCP manual for full benefit limitations. No. No. Supplemental Security Income (SSI) Full coverage of medically necessary services. No. Yes; under Hoosier Care Connect or Care Select. Traditional Medicaid Fee for Service (FFS) Full coverage of medically necessary services. No monthly premium, some co- pays for Rx, non-emergent ER and transportation. No. Care Select (*Program to end on 6/30/15) Full coverage of medically necessary services. *Includes dental, eye care and transportation. No monthly premium, some co- pays for Rx. Yes. Hoosier Care Connect (HCC) Full coverage of medically necessary services. *Includes dental, eye care and transportation. No. Yes. Adult Hospital Presumptive Eligibility (HPE) Full coverage of medically necessary services. Co-pays required for Rx and most office visits. Yes. HIP PlUS Full coverage of medically necessary services. *Includes dental, eye care and transportation. Member pays contributions to their POWER account, co-pays required for non-urgent ER visits. Yes. HIP BASIC Full coverage of medically necessary services. No dental, eye care or transportation. *Co-pays required for most office visits, services, inpatient stays and non-emergent ER visits. Yes. HIP State Plan PLUS Full coverage of medically necessary services. *Includes dental, eye care and transportation. Member pays contributions to their POWER account, co-pays required for non-urgent ER visits. Yes. HIP State Plan BASIC Full coverage of medically necessary services. *Includes dental, eye care and transportation. *Co-pays required for most office visits, services, inpatient stays and non-emergent ER visits. Yes. *Check the IHCP Web InterChange for co-pay requirement information for HIP and HIP State Plan members. The co-pay indicator may be eliminated for various reasons (for example: pregnancy status). UPDATED 3.18.15 HHW-HIPP0445 (5/15)

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