Hip Insurance: Hmo Or Not?

The Healthy Indiana Plan (HIP) is a consumer-driven health coverage program for non-disabled Indiana residents aged 19-64. HIP is not considered an HMO (Health Maintenance Organization) as it is a state-government-sponsored program. However, HIP members can choose from four health plans, including Anthem, CareSource, MDwise, and MHS, which may include HMO options. EmblemHealth, a private health insurance company, offers the HIP HMO Preferred Plan for City of New York employees. This plan provides access to top doctors and hospitals, health coaching, mental health services, and industry-leading hospitals such as Memorial Sloan Kettering Cancer Center and Hospital for Special Surgery.

HIP HMO Preferred Plan for City of New York Employees

The HIP HMO Preferred Plan for City of New York Employees is a health insurance plan offered to city employees through the City of New York Health Benefits Program. EmblemHealth, a subsidiary of HIP HMO, is proud to partner with the City of New York in offering this innovative health benefit program.

The HIP HMO Preferred Plan is considered a "non-grandfathered health plan" under the Affordable Care Act, meaning it must comply with certain consumer protections and cover specific in-network preventive services with $0 co-payments. These services include routine physicals, immunizations, colonoscopies, mammograms, and birth control prescriptions.

The plan offers affordable health insurance that covers top doctors and hospitals, with a focus on providing excellent service. Members have access to industry-leading hospitals, such as the Memorial Sloan Kettering Cancer Center for cancer care and the Hospital for Special Surgery for orthopedics and musculoskeletal conditions.

One of the key benefits of the HIP HMO Preferred Plan is the availability of health coaching tailored to the member's needs. Members can access one-on-one, group, or text message coaching from trained health coaches or nurse wellness coaches at no extra cost. This includes voluntary personalized coaching with one-on-one goal setting, as well as guided advice on fitness, nutrition, and stress management.

Additionally, the plan provides access to a robust network of quality doctors, known as the Prime Network. This network includes over 100,000 doctors across New York, New Jersey, and Connecticut. Members who choose a preferred primary care doctor within this network will have a $0 copay for most services, including referrals to specialists within the network. If a member selects a non-preferred primary care doctor in the Prime Network, the copay is typically $10 for most services, including specialist visits.

It is important to note that care received from out-of-network providers is generally not covered by the HIP HMO Preferred Plan, except in cases of emergencies. Members are encouraged to utilize the in-network services within the Prime Network to ensure coverage and pay less.

Overall, the HIP HMO Preferred Plan for City of New York Employees offers comprehensive health benefits, personalized coaching, and access to a wide range of quality healthcare providers, making it a valuable option for city employees.

HIP HMO Preferred Plan covers mental health and substance abuse services

The HIP HMO Preferred Plan covers mental health and substance abuse services. This includes outpatient mental health services and inpatient hospital care.

The HIP HMO Preferred Plan is offered by EmblemHealth and is available to New York City employees. The plan provides access to top doctors and hospitals, as well as health coaching and dedicated Gold Line Service. Members can also benefit from AdvantageCare Physicians, a primary and specialty care medical group with 37 offices across Brooklyn, Manhattan, Queens, Staten Island, and Long Island.

The HIP HMO Preferred Plan covers services within the Prime Network, which includes over 100,000 doctors across New York, New Jersey, and Connecticut. Services received outside of this network may not be covered, except in emergencies.

The HIP HMO Preferred Plan covers mental health and substance abuse programs and services, with confidential help available 24/7. This includes outpatient mental health services, which do not require a referral from a primary care doctor.

In addition to mental health services, the HIP HMO Preferred Plan also covers inpatient hospital care, routine physical exams, outpatient physical therapy, and telemedicine through Teladoc.

The Healthy Indiana Plan (HIP)

The HIP program offers two pathways to coverage: HIP Plus and HIP Basic. HIP Plus is the initial plan selection for all members, offering comprehensive benefits, including vision, dental, and chiropractic services. Members are required to make affordable monthly contributions to their Personal Wellness and Responsibility (POWER) account, which is used to pay for the first $2,500 of medical expenses. The state pays most of this amount, with the member responsible for a small portion based on their income. HIP Plus has no copayments except for non-emergency visits to the emergency room.

On the other hand, HIP Basic is a fallback option for members with household incomes less than or equal to 100% of the federal poverty level who don't make their POWER account contributions. The benefits under this plan are more limited and include only essential health benefits. Members are required to make a copayment for each healthcare service they receive, such as doctor visits, prescriptions, or hospital stays. These copayments can range from $4 to $8 per visit and may be as high as $75 per hospital stay.

The Healthy Indiana Plan also offers incentives for members to take personal responsibility for their health and make cost-conscious healthcare decisions. For example, members who manage their POWER accounts well and receive preventive care may reduce their future costs by rolling over remaining contributions to lower their monthly payments for the following year. Additionally, the program aims to improve the health status of Hoosiers, provide quality coverage choices, and address the opioid crisis by providing additional substance use disorder services.

HIP Plus and HIP Basic

The Healthy Indiana Plan (HIP) is a health insurance program offered by the state of Indiana for qualified adults. The plan covers medical, dental, vision, and chiropractic costs for members. It also rewards members for taking better care of their health. The program covers Hoosiers aged 19 to 64 who meet specific income levels.

HIP Basic, on the other hand, is the fallback option for members with household incomes less than or equal to 100% of the federal poverty level who don't make their POWER account contributions. The benefits under HIP Basic are reduced. While it covers essential health benefits, it does not include vision, dental, or chiropractic services. Members are required to make a copayment each time they receive a healthcare service, such as going to the doctor, filling a prescription, or staying in the hospital. These payments may range from $4 to $8 per doctor visit or prescription filled and may be as high as $75 per hospital stay. HIP Basic can be more expensive than HIP Plus, especially if members have frequent doctor visits, prescriptions, or hospital stays.

HIP Maternity

The Healthy Indiana Plan (HIP) is a health coverage program for non-disabled Indiana residents aged 19-64. It is sponsored by the state and offers full health benefits, including hospital care, mental health care, doctor care, prescriptions, and diagnostic care.

• Vision, dental, medical, and chiropractic coverage
• Non-emergency transportation
• Behavioral health services
• Substance use disorder services
• Smoking cessation services designed for pregnant members

Frequently asked questions