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Healthy Indiana Plan Member Handbook Serving Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging

Healthy Indiana Plan Member Handbook Serving Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging Inside Cover
MEMBER HANDBOOK Anthem
To get this handbook in other formats, such as Braille, large print, or audio CD, call our Member Services at 866-408-6131 (TTY 711), Monday through Friday, 8 a.m. to 8 p.m. Eastern time.
You can learn more about Anthem on our website at anthem.com/inmedicaid. 1022394INMENABS 04/25

Healthy Indiana Plan Member Handbook Table of contents Welcome to Healthy Indiana Plan ...............................................................................................4 Working with Anthem......................................................................................................................5 Important phone numbers..........................................................................................................5 Part 1 – All about your HIP Plan.....................................................................................................9 Healthy Indiana Plan (HIP) benefit plans ...............................................................................9 Member identification .................................................................................................................9 Plan selection period/changing health plans .......................................................................9 Programs and covered services .............................................................................................. 13 Self-referral services.................................................................................................................. 22 Other services .............................................................................................................................. 22 Services not offered by Anthem include...............................................................................23 Preapproval (an OK from Anthem) ........................................................................................ 23 Dental benefits................................................................................................................................24 Pregnancy and postpartum care................................................................................................25 Your HIP POWER Account .............................................................................................................28 PAC tiers table .............................................................................................................................29 Part 2 – Ways to great health...................................................................................................... 33 How to choose your PMP........................................................................................................... 33 Enhanced benefits .......................................................................................................................... 37 Preventive care........................................................................................................................... 40 After-hours care ..........................................................................................................................43 Urgent care ...................................................................................................................................43 Emergency services ....................................................................................................................43 Transportation............................................................................................................................ 45 Behavioral health and substance use disorder ................................................................. 46 Part 3 – Pharmacy services...........................................................................................................48 Part 4 – Help with special services ............................................................................................. 51 Language assistance ................................................................................................................. 51 Hearing and speech assistance............................................................................................... 51 Redetermination .............................................................................................................................52 2

Part 5 – Member rights and responsibilities ........................................................................... 54 Part 6 – How to resolve a problem with Anthem................................................................... 59 How to get help .......................................................................................................................... 59 Grievances and appeals........................................................................................................... 59 Choosing a new health plan.........................................................................................................62 Index................................................................................................................................................... 67 Words and acronyms used in this manual ............................................................................... 67 Notice of Privacy Practices.......................................................................................................... 69 3

Welcome to Healthy Indiana Plan The Indiana Family and Social Services Administration (FSSA) offers Medicaid services for eligible Hoosiers through Healthy Indiana Plan (HIP). Through the HIP program, we’ll help take care of your physical, behavioral, medical, and social needs. We’ll coordinate your care with all your doctors and specialists. Our goal is to help you live healthy. This manual will provide you with information on how Anthem works and important resources. Contact us Mailing address: Anthem Blue Cross and Blue Shield Mailstop IN0205 C442 220 Virginia Ave. Indianapolis, IN 46209-6227 Online: anthem.com/inmedicaid Hours of operation Anthem is open for business Monday through Friday, 8 a.m. to 8 p.m. Eastern time. Anthem is closed on New Year’s Day, Martin Luther King, Jr. Day, Memorial Day, Independence Day (July 4th), Labor Day, Thanksgiving Day and, and Christmas Day. Technology at your service Anthem offers online tools to make it easier for you to access care and services. With our secure member website and Sydney Health, our mobile app, you can manage your healthcare with a few clicks. Just go to our website at anthem.com/inmedicaid to set up your secure account. Once you are registered, you can: • Choose or change doctors. • Order a new ID card. • Look at the status of claims. • See your care plan. • Contact Member Services. • Have messages/communications sent to your account. It’s easy, and you’ll be able to get things done without the wait. 4

Working with Anthem Welcome to your Anthem Healthy Indiana Plan (HIP) member handbook. Read this quick guide to find out about: • Your benefits. • Important phone numbers. • Choosing a primary medical provider (PMP). • Pharmacy services. • Ways to good health. Important phone numbers Service Area Phone number Information Member Services 866-408-6131 (TTY 711) Hours: Monday through Friday from 8 a.m. to 8 p.m. Eastern time. Call for questions about: • Anthem coverage. • Behavioral health. • Service coordinator. • Pharmacy benefits. • Utilization management. 24/7 NurseLine 866-408-6131 (TTY 711) A nurse is available 24 hours a day, seven days a week. Behavioral Health Crisis Hotline 833-874-0016 (TTY 711) Speak to a licensed behavioral health professional when you are going through a mental health or substance use crisis. You can call 24 hours a day, seven days a week. Healthy Rewards 888-990-8681 (TTY 711) Hours: Monday through Friday from 8a.m. to 8 p.m. Eastern time. Suicide & Crisis Lifeline 988 Providing 24/7, free, and confidential support for those experiencing a suicidal crisis or emotional distress. Utilization Management (UM) 866-408-6131 (TTY 711) Hours: Monday through Friday, 8 a.m. to 5 p.m. Eastern time. Call for questions about UM or an approval request. You may ask for an interpreter. If after hours, you can leave a private message. Staff will return your call the next 5

business day or at a different time upon request. Staff will tell you their name, title, and organization when making or returning calls. Transportation Services 844-772-6632 (TTY 888-238-9816) Call to set up transportation to your doctor appointments. Calls for routine reservations are accepted Monday through Friday from 8 a.m. to 8 p.m. Eastern time. Calls for urgent and same-day reservations are accepted 24/7. Calls for cancellations, status updates, and hospital discharges are accepted 24/7. For more information, see the Transportation section of this handbook. Relay Indiana 800-743-3333 (TTY 711) For members with hearing or speech loss, a trained person will help them speak to someone using a standard phone. Vision Member Services 866-866-5641 (TTY 800-428-4833) Member Services is available to help you find information about your vision benefits and how to find a provider in your area. ) Division of Family 800-403-0864 Call to report any Resources (DFR) information changes such as a change in your telephone number, family size, address, and income. Dental Member Services 888-291-3762 (TTY 800-466-7566) Find a dentist in your area or learn more about dental benefits available to you. Quit Now Indiana 800-784-8669 or text ‘READY’ to 34191 Free phone-based service to help smokers quit. Translation or format services 866-408-6131 (TTY 711) Call this number to request member materials such as this handbook in other languages or formats including Braille, large print, or audio CD. Translations and other formats are available for free. 6

HIP Enrollment Broker 877-438-4479 Can help answer questions on changing plans or update member status. How and when to report changes Anthem keeps your information on file for many reasons. It is important that your information is up-to-date. Whenever you have a change of information, you need to report it to Anthem. In some cases, you will also need to report your changes to the Department of Family Resources (DFR). Reporting changes to your health plan Anthem should be updated on your information. This can be things like: • Name • Address • Phone number • Change in insurance (such as getting another insurance plan) Reporting changes to the Division of Family Resources (DFR) The Division of Family Resources should be updated on all of your general information. If you have a change in any of these, you must let the DFR know. You can go online at fssabenefits.in.gov. or call 800-403-0864 from 8 a.m.-4:30 p.m. local time to report your changes to the DFR. • Name • Address • Phone number • Change in family size • Change in income • Change in insurance (such as getting another insurance) Sydney Health mobile app The Sydney Health mobile app puts your healthcare at your fingertips. Download it for free on the App Store® and Google PlayTM. You can use the app to: • Check your POWER Account. • Find a doctor, hospital, or pharmacy in your plan. • View your claims. • See your care plan. • Check your symptoms. • Talk with a nurse 24/7 about your health. • Receive a copy of your Member ID card electronically. 7

Anthem Concierge Unit Managing healthcare can be hard. That’s why we created the Anthem Concierge Unit. This service can help you: • Complete your Health Needs Screening (HNS). • Schedule appointments with your primary medical provider (PMP). • Connect to community services like Women, Infants, and Children (WIC). Call 866-408-6131 (TTY 711) for the Concierge Unit today. You can also write the Anthem Concierge Unit at: Anthem Blue Cross and Blue Shield Mailstop IN0205 C442 220 Virginia Ave. Indianapolis, IN 46209-6227 Also check out these Anthem webpages for special programs. Program Web address Details Healthy Rewards anthem.com/ AnthemRewards Offers many rewards for staying healthy. Blue Ticket to Health anthem.com/blueticket We teamed up with the Indianapolis Colts so you can win prizes for getting your wellness checkup or annual dental exam. HIP Plus chooseanthem.com/in HIP Plus offers the best value with extra benefits and no copays. Anthem Third-party Payment Center anthem.com/Pay4HIP For employers and groups, like churches and foundations, that would like to pay a HIP member’s POWER Account Contribution (PAC). This site is for employers and groups only. It is not for HIP members. 8

Part 1 – All about your HIP Plan Healthy Indiana Plan (HIP) beneﬁt plans • HIP Plus: the preferred plan for all members, with extras like dental, vision, chiropractic care, and no copays. • HIP Basic: essential but limited health benefits. • HIP State plan: includes some added benefits for certain members. • HIP Maternity plan: benefits for pregnant members. See All about the Healthy Indiana Plan in Part 1 for more details. How do I know what kind of care I need? We can help you ﬁnd out. Just take the Health Needs Screening (HNS). Your answers will help us ﬁnd the right healthcare for you. You will earn up to $50 if you take your HNS in the ﬁrst 90 days of enrollment. To take the HNS, visit hns.anthem.com/login or call 888-298-7902. Member identiﬁcation As a HIP member, you will receive an Anthem member ID card that includes your 12-digit Medicaid member ID number. Your member ID card is very important. Remember to keep your member ID card with you at all times. Remember these four things for your member ID: • Keep your member ID card with you at all times. It shows you are an Anthem member and have the right to get healthcare • You can also locate your Member ID on the Sydney Health App. • Show this ID card every time you need healthcare services. Only you can get healthcare services with your ID card. Do not let anyone else use your card. • If you lose your card, ask for a replacement card. Log in at anthem.com/inmedicaid. Or, you can call Member Services at 866-408-6131 (TTY 711). Plan selection period/changing health plans With HIP, you must remain in your chosen health plan for a one-year period if you remain eligible. You may only change Anthem during certain times of the year or for certain reasons. Individuals will have the chance to change a health plan: 1) Within 60 days of starting coverage. 2) Once per calendar year for any reason. 3) At any time using the just-cause process. See the section Grievances and Appeals “just-cause reasons.” 4) Additionally, during the plan selection period (November 1–December 15), to be effective the following calendar year. 9

Care management Healthcare can be overwhelming, so we’re here to help you stay on top of it. Your care manager will help you: • Figure out your care plan. • Answer questions. • Get you to the services you need. • Coordinate with your doctors and support system. If you’ve experienced a critical event or health issue that is complex, we’ll help you learn more about your illness and develop a plan of care through our complex care management program. Access to complex care management We use data to find out which members qualify for our complex care management program. You can be referred to complex care management through our: • 24/7 NurseLine. • Condition Care program. • Discharge planner. • Utilization management. • Member or caregiver referral. • Your doctor or other provider. If you have one of these health issues or another complex or special health issue and want to learn more about care management, call Member Services at 866-408-6131 (TTY 711). Connecting with care management Providers, nurses, social workers, and members or their representatives may refer you to care management in one of two ways: Phone: 866-902-1690 (TTY 711) Fax: 855-417-1289 A care manager will respond to a faxed request within three business days. Condition Care Our Condition Care program helps guide the care for our members with chronic health conditions. The program is voluntary, private, and available at no cost to you from the Condition Care Centralized Care Unit (CCCCU) team. Our team of licensed nurses, called CCCCU care managers, will help you understand your condition and help you meet healthcare goals through education, resources, and referrals to providers for care. You can join the program if you have one of these conditions: • Attention-deficit/hyperactivity disorder (ADHD) • Asthma 10

• Autism • Bipolar disorder • Chronic kidney disease • Chronic obstructive pulmonary disease (COPD) • Congestive heart failure • Coronary artery disease • Diabetes • HIV/AIDS • Hypertension • Major depressive disorder – adult • Major depressive disorder – child and adolescent • Pregnancy • Schizophrenia • Sickle cell disease • Substance use disorder Our care managers assist with weight management and smoking cessation services. Your care manager will: • Listen to you and take the time to understand your specific needs. • Help you make a care plan to reach your healthcare goals. • Give you the tools, support, and community resources that can help you improve your quality of life. • Provide health information that can help you make better choices. • Help you coordinate care with your providers. How to join: We’ll send you a letter welcoming you to a Condition Care program, if you qualify. Or, call us toll free at 888-830-4300 (TTY 711) from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday. When you call, we’ll: • Set you up with a care manager to get started. • Ask you some questions about your health. • Start working together to create your plan. You can also email us at Condition-Care-Self-Referral@anthem.com.  
Please be aware that emails sent over the internet are usually safe, but there is some risk as third parties may access (or get) these emails without you knowing. By sending your information in an email, you acknowledge (or understand) third parties may access these emails without you knowing. You can choose to opt out (we’ll take you out of the program) at any time. Please call us toll free at 888-830-4300 (TTY 711) from 8:30 a.m. to 5:30 p.m. Eastern time, Monday 11

through Friday to opt out (leave the program). You may also call this number to leave a private message for your care manager 24 hours a day. For more information, visit anthem.com/inmedicaid and select Manage Your Condition under the Health & Wellness Resources tab. You can also call 888-830-4300 or the Behavioral Health Crisis Line at 833-874-0016.
Condition Care (CNDC) Program When you join a CNDC program, you have certain rights and responsibilities. You have the right to: • Get details about us, such as: o Programs and services we offer. o Our staff and their qualifications (skills or education). o Any contractual relationships (deals we have with other companies). • Opt out of CNDC services. • Know which CNDC care manager is handling your services and how to ask for a change. • Get support from us to make healthcare choices with your healthcare providers. • Ask about all CNDC-related treatment options (choices of ways to get better) mentioned in clinical guidelines (even if treatment is not part of your health plan) and talk about options with treating healthcare providers. • Have personal data and medical information kept private. • Know who has access to your information and how we make sure your information stays secure, private, and confidential. • Receive polite, respectful treatment from our staff. • Get information that is clear and easy to understand. • File complaints to Anthem by calling 888-830-4300 (TTY 711) toll free from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday, and: o Get help on how to use the complaint process. o Know how much time Anthem has to respond to and resolve issues of quality and complaints. o Give us feedback about the program. You also have a responsibility to: • Follow the care plan that you and your CNDC care manager agree on. • Give us information needed to carry out our services. • Tell us and your healthcare providers if you choose to opt out (leave the program). 12

Condition Care does not market products or services from outside companies to our members. Condition Care does not own or profit from outside companies on the goods and services we offer. Autism spectrum disorders program Individuals and families touched by autism can speak with care managers from our autism spectrum disorders (ASD) program. We offer a support system to help members understand the care that’s available. Our goal is to help individuals and families gain confidence in navigating the resources available. Substance use disorder program Anthem’s substance use disorder (SUD) program helps members with major substance use issues improve their overall health. Our care managers work with you to identify long-term goals, helping you strive for a healthier lifestyle. Programs and covered services From preventive care to vision and pharmacy services, we are here to help you get and stay healthy. Learn more about the different HIP plans and what is covered. There are a few different kinds of Healthy Indiana Plan, or HIP, benefit plans. HIP Plus HIP Plus provides the most benefits, including: • Dental care • Vision care • Chiropractic care • No copays HIP Basic HIP Basic offers essential services, but: • Does not include everything HIP Plus does. • Does not include vision or dental services, except for members who are 19 or 20 years of age and pregnant members. • Does not include chiropractic services. Members must pay copays. HIP Basic and HIP Plus covered services The services listed below are for members in either HIP Basic or HIP Plus. A copay is the amount you pay each time you go to the doctor or get a prescription. In HIP, members who are American Indian/Alaska Native, pregnant, or who have hit the 5% cost-sharing limit do not have copays. Copays also do not apply to HIP Plus members, except for use of the emergency room when it is not an emergency. Benefits Details Copay Doctor care Includes: • Preventive care • Early and Periodic Screening, Diagnosis, and Treatment Basic: $4 for visits to the doctor and specialists. No copay for preventive care, including wellness 13

Benefits Details Copay (EPSDT) program services, including routine dental visits, wellness visits, and lead screening • Physical exams • Immunizations • Specialty care exams, screenings, and shots. Emergency room Basic and Plus: $8 for ER use if it is not an emergency. Hospital Inpatient services Basic: $75 Outpatient services and surgeries • Bariatric (weight-loss) surgery is covered under HIP Plus Basic: $4 Lab tests and X-rays Basic: $4 Post-stabilization services Care provided in the ER or hospital after your condition is stable or improved, but before you leave the ER or hospital. No copay Ambulance transportation for emergencies Ride service to the emergency room (ER) No copay Medical supplies Includes: • Durable medical equipment • Hearing aids • Orthotics and prosthetic devices Basic: $4 Physical, speech, occupational, respiratory, and cardiac therapy • Basic: Up to 60 treatments for each episode per benefit period • Plus: Up to 75 treatments per benefit period Basic: $4 Behavioral health Care for mental health/substance abuse Basic: $4 Prescription services Provided by CarelonRx includes: • Prescription drugs • Members enrolled in HIP Basic pay: $8 copay for nonpreferred 14

Benefits Details Copay • OTC drugs with a prescription • Diabetic supplies • Specialty drugs (some high- cost drugs are paid for by FSSA/OptumRx) • $4 copay for preferred prescriptions There are no pharmacy copays for HIP Plus. Smoking cessation Includes: • Prescription and over-the counter treatment, such as nicotine patches or gum • Counseling services No copay Renal dialysis Coverage provided for home dialysis services. Basic: $4 Home healthcare Services include, but are not limited to, nursing care given or supervised by an RN and nutritional counseling. • 100 visits per year Basic: $4 Skilled nursing facility Up to 100 days Basic: $75 Hospice care Provided in a facility or in the home for terminal illness, as part of a treatment plan before starting the program. No copay Nurse practitioner services A nurse practitioner is a nurse who works with a primary medical provider (PMP). Basic: $4 Nonemergency transportation Not a covered benefit. Eligible HIP Plus members receive limited transportation support as an enhanced benefit – see Enhanced Benefits section below. No copay Dental See Dental Benefits Summary below. No copay Temporomandibular joint disorder (jaw disorder) Offered under HIP Plus No copay Vision Approved for all Plus members and Basic members ages 19 and 20 Exams • One eye exam per year for members under 21 years old No copay 15

Benefits Details Copay • Individual, group, and family therapy. • Mental health services provided by physicians, psychiatric wings of acute care hospitals, outpatient mental health facilities, and psychologists endorsed as health service providers. • Behavioral health services not provided by the above providers, but include mental health, substance abuse, and chemical dependency services rendered by mental health specialty providers. Substance use disorder and opioid treatment services* Anthem covers recovery supports for substance use treatment, including: • Peer recovery services • Intensive outpatient • Partial hospitalization • Residential treatment • Medication-assisted treatment Some services require prior approval. We also provide full coverage for Opioid Treatment Program (OTP) services, including: • All levels of care for methadone use. • Medication-assisted treatment. • Associated counseling. Prior approval is not required for OTP services. We contract with all Division of Mental Health and Addiction No copay 17

Benefits Details Copay (DMHA) certiﬁed OTP providers across Indiana.

Prior approval required under certain circumstances. * Prior approval is always required. What’s the best deal? HIP Plus offers the most value — no copays, plus dental, vision, chiropractic services, and extra pharmacy benefits. HIP Basic can cost more than paying a monthly contribution to your HIP Plus POWER Account. See the POWER Accounts section in Part 1. HIP benefits and copay comparison guide Service HIP Plus Plan HIP Basic Plan Doctor care No copay Copay Hospital services No copay Copay Lab tests and X-rays No copay Copay Dental care No copay Not covered Vision services No copay Not covered* Diabetes management training No copay No copay Chiropractic services No copay Not covered Family planning No copay No copay Bariatric (weight loss) surgery No copay Not covered Skilled nursing care No copay Copay Emergency care Copay if not a true emergency Copay if not a true emergency Nurse practitioner services No copay Copay Transportation — nonemergency No copay Not a covered benefit for HIP Regular Plus Plan No copay Not a covered benefit for HIP Regular Basic Plan Pharmacy and OTC drugs No copay Copay Urgent care clinic No copay Copay
Covered for members who are pregnant or age 19–20 with no copay. What is a POWER Account? The first $2,500 of your approved healthcare costs are paid with your Personal Wellness and Responsibility Account, also called the POWER Account. HIP Plus members make a small monthly payment (called a contribution) to their POWER Account. But, they don’t have copays, like HIP Basic members do. 18

What is a contribution? If you’re in the HIP Plus plan, you must make monthly payments to pay your part of the POWER Account. These payments are your contributions. You will get a bill each month for the payment you need to make. Make your monthly payments on time. HIP State plan benefits HIP State plan benefits include some extra benefits for members who are: • Low-income parents and caretakers, and 19- and 20-year-old dependents.
• Medically frail.
There are two different kinds of HIP State plans. With HIP State Plan Plus, you pay monthly contributions, so you know how much your healthcare will cost you. With HIP State Plan Basic, you pay copays, which can add up quickly and cost more. Medically frail To be medically frail, you must have one or more of the following conditions: • Disabling mental disorder • Chronic substance abuse disorder • Serious and complex medical condition • Physical, intellectual, or developmental disability that impairs daily living • Disability determination from the Social Security Administration If you qualify as medically frail, we’ll need to confirm this each year. For more information or questions about being in the medically frail category, call Member Services at 866-408-6131 (TTY 711). If you qualify as medically frail, you may have to pay monthly contributions and pay copays if your income is over 100% of the Federal Poverty Level and you fail to make timely payments to your POWER Account. HIP Maternity plan If you qualify for HIP and you are pregnant or become pregnant while in HIP, you will be enrolled in the HIP Maternity plan. With HIP Maternity: • You have no copays. • You have no POWER Account payments during the pregnancy. • Your POWER Account is frozen while you are on the Maternity plan, so no medical expenses are deducted from your POWER Account. • During your pregnancy, you get all the great benefits you received under your regular HIP plan, like doctor, hospital, and lab services, plus added benefits including vision, dental, and chiropractic services as well as rides to doctor appointments. At the end of your pregnancy, you will receive 12 months of postpartum benefits. Following that period, you will move to the HIP Basic plan and be given an opportunity to make a POWER Account payment to move to HIP Plus. 19

HIP State plans and HIP Maternity benefits Services offered by Anthem The services listed below are for members in either a HIP State plan or HIP Maternity. Copays do not apply to HIP State Plan Plus and HIP Maternity members. Benefits Details Copay Doctor care Includes: • Preventive care • Physical exams • Prenatal care • Annual checkups • Immunizations • Specialty care State Basic: $4 for visits to the doctor and specialists. No copay for preventive care, including wellness exams, screenings, and shots. Emergency room State Basic and Plus: $8 for ER use if it is not an emergency. Hospital Inpatient services State Basic: $75 Outpatient services and surgeries State Basic: $4 Lab tests and X-rays State Basic: $4 Post-stabilization services Care provided in the ER or hospital after your condition is stable or improved, but before you leave the ER or hospital. No copay Ambulance transportation for emergencies Ride service to the emergency room (ER) No copay Medical supplies Includes: • Durable medical equipment • Hearing aids • Orthopedic shoes and leg braces • Orthotics and prosthetic devices State Basic: $4 Therapy services Physical, speech, occupational, and respiratory therapy State Basic: $4 Behavioral health Care for mental health/substance abuse State Basic: $4 Prescription services Provided by CarelonRx includes: • Prescription drugs • OTC drugs with a prescription • Diabetic supplies • Specialty drugs (some high-cost drugs are paid for by FSSA/OptumRx) Members enrolled in HIP State Plan Basic pay: • $8 copay for nonpreferred • $4 for preferred prescriptions. 20

Benefits Details Copay There are no pharmacy copays for HIP State Plan Plus. Smoking cessation Includes: • One 12-week course of treatment per calendar year • Prescription and OTC medicines, such as nicotine patches or gum • Counseling services No copay Renal dialysis Coverage provided for home dialysis services. State Basic: $4 Home healthcare • Services include, but are not limited to, nursing care given or supervised by RN and nutritional counseling • 100 visits per year State Basic: $4 Skilled nursing facility HIP Maternity Up to 60 days per rolling 12-month period. State Basic and Plus Up to 100 days per rolling 12-month period. State Basic: $75 Hospice care Provided in a facility or in the home for terminal illness, as part of a treatment plan before starting the program. No copay Nurse practitioner services A nurse practitioner is a nurse who works with a primary medical provider (PMP). State Basic: $4 Nonemergency transportation • Unlimited trips to Medicaid providers • A trip is defined as door-to-door service, mileage reimbursement for member or driver, or bus passes • Additional transportation benefits are available — see Enhanced Benefits section below No copay Dental See Dental Benefits Summary below. No copay Vision services Exams • One eye exam per year for members under 21 years old State Basic: $4 21

Benefits Details Copay • One eye exam every two years for members 21 years and older Eyeglasses • One pair of eyeglasses per year for members under 21 years old, unless medically necessary under EPSDT • One pair of eyeglasses every five years for members 21 years and older Podiatry services One office visit per year for HIP State Plan members only. State Basic: $4 Chiropractic services Up to six visits per year and 50 therapeutic physical medicine treatments per year. Chiropractors are allowed to perform therapy services if licensed. State Basic: $4 Self-referral services HIP includes some beneﬁts and services that are available to members on a self- referral basis. These self-referral services do not require a referral from your PMP or approval. You can receive self-referral services from any Indiana Health Care Plan (IHCP) provider, even if they aren’t contracted with Anthem, except for certain behavioral health services. Self-referral services include: • Chiropractic care (not covered for HIP Basic members) • Routine dental services (covered in all HIP Plans, except in the HIP Basic plan, which is covered for members ages 19–20 only) • Diabetes self-care training • Emergency services • Eye and vision care (except surgical services) (covered in all HIP Plans, except in the HIP Basic plan, which is covered for members ages 19–20 only) • Family planning • HIV/AIDS care management • Immunizations • Behavioral health/psychiatric services (behavioral health providers who are not psychiatrists must be contracted with Anthem) • Podiatry services (HIP State Plan members only) • Urgent care Other services Indiana Health Coverage Programs (IHCP) covers some types of care for members. These types of services are called carve-outs. You may get these services from any IHCP-enrolled doctor. Carve-out services include: 22

• Medicaid Rehabilitation Option (MRO) — offers various mental health services to help members achieve their best health in daily life. • 1915(i) Waiver wrap-around services — includes services such as Behavioral and Primary Healthcare Coordination (BPHC) and Adult Mental Health and Habilitation (AMHH) services for members who may have special needs. • Individualized Education Plan services — to assist members who need extra help with their education goals. To find out more about these services, speak with your care manager or call Member Services at 866-408-6131 (TTY 711). Services not offered by Anthem include: • Services that are not medically necessary. • Nursing home (for more than allowed under plan benefits) or long-term care facility services. • Intermediate Care Facility Services (ICF/MR). • Services under the Home- and Community-Based Services (HCBS) waiver. • Psychiatric state hospital or residential treatment. • Services/care you receive in another country. • Acupuncture. • Experimental or investigational treatments. • Cosmetic surgery (this does not apply to reconstructive surgery). • Alternative medicine. • Drugs or surgery to help you get pregnant. • Vitamins, supplements, and over-the-counter (OTC) medicines not covered through the pharmacy benefit. • Private duty nursing. • For any condition, disease, defect, ailment, or injury that takes place while working if you have workers’ compensation. • The evaluation or treatment of learning disabilities. Preapproval (an OK from Anthem) Your PMP will need to get an OK from us for some services to make sure they’re offered. This means that both Anthem and your PMP or specialist agree the services are medically necessary. We may ask your doctor why you need special care. Getting an OK will take no more than 48 hoursor, if urgent, no more than 24 hours. We may not OK payment for a service you or your doctor asks for. If so, we’ll send you and your doctor a letter that explains why. The letter will let you know how to appeal our decision if you disagree with it. See the Appeals section in Part 6. If you have questions, you or your doctor may call us at Member Services or our 24/7 NurseLine at 866-408-6131 (TTY 711). Or write us at: 23

Anthem Blue Cross and Blue Shield P.O. Box 62509 Virginia Beach, VA 23466 Dental beneﬁts Dental benefit summary Good dental health makes a big difference in your overall health, no matter how old you are. That’s why it’s important for you to keep your dental appointments and use your recommended dental benefits. Your dentist will tell you if the dental care you need is covered and if there are copays. Your dentist will also help you if you need an OK for dental care. Benefits are based on a treatment code and/or medical necessity. Do you need help understanding your benefits, finding a dentist, or making an appointment? Please call DentaQuest at 888-291-3762 (TTY 711). Benefit level Oral examinations Cleanings X-rays HIP Basic (ages 19–20) 2 exams per year 2 cleanings per year 1 complete set every 3 years 1 set of bitewing X-rays every 12 months HIP Basic (ages 21+) No coverage No coverage No coverage HIP Plus 2 exams per year 2 cleanings per year 1 complete set every 3 years 1 set of bitewing X-rays every 12 months HIP State Plan (ages 19–20) (State Plan Plus and State Plan Basic) 2 exams per year 2 cleanings per year 1 complete set every 3 years 1 set of bitewing X-rays every 12 months HIP State Plan (ages 21+) (State Plan Plus and State Plan Basic) 2 exams per year 1 cleaning per year 1 complete set every 3 years 1 set of bitewing X-rays every 12 months 24

HIP Maternity (ages 19–20) 2 exams per year 2 cleanings per year 1 complete set every 3 years 1 set of bitewing X-rays every 12 months HIP Maternity (ages 21+) 2 exams per year 1 cleaning per year 1 complete set every 3 years 1 set of bitewing X-rays every 12 months

HIP State Plan Basic members have a $4 copay per type of dental service. For example, for fillings done on the same day, you will owe one $4 copay. There is no copay for preventive services like exams and cleanings. Members who are American Indian/Alaska Native, pregnant, or who have hit the 5% cost-sharing limit, don’t have copays. Pregnancy and postpartum care As soon as you know you are pregnant: • Call Member Services toll free at 866-408-6131 (TTY 711). • See your doctor for prenatal care — this is the care you get while you are pregnant. Our staff will make sure your doctor and hospital are in your plan. At your first prenatal care visit, your doctor should schedule additional visits throughout your pregnancy to keep you and your baby healthy. Seeing your doctor regularly during your pregnancy is important. • When you become pregnant, you will move to the HIP Maternity plan. You will remain in this plan for 12 months after the end of your pregnancy. • Know that while pregnant, you won’t have to make payments to your POWER Account or have copays for healthcare services. • If you need behavioral healthcare, you can go to any Indiana Health Coverage Programs (IHCP) doctor. New Baby, New Life℠ It is very important to see your primary medical provider (PMP) or obstetrician or gynecologist (OB-GYN) for care when you are pregnant. This kind of care is called prenatal care. It can help you to have a healthy baby. Prenatal care is important each time you are pregnant. With our program, you’ll have access to health information and may receive incentives for going to your appointments. Our program also helps pregnant individuals with complicated healthcare needs. Nurse care managers work closely with these individuals to provide: • Education. • Emotional support. • Help in following their doctor’s care plan. • Information on services and resources in your community. 25

Our case managers also work with OB providers and help with other services you may need. The goal is to promote better health for pregnant members and the delivery of healthy babies. When you become pregnant If you think you are pregnant: • Call your PMP or OB-GYN doctor right away. You do not need a referral from your PMP to see an OB-GYN doctor. • Call Member Services at 866-408-6131 (TTY 711) if you need help finding an OB-GYN in the Anthem network. When you find out you are pregnant, you must also call Member Services at 866-408-6131 (TTY 711). You should also report your pregnancy to Indiana Family and Social Services Administration (FSSA) at 800-403-0864. Visit our Pregnancy & Women’s Health page at anthem.com/inmedicaid under Health & Wellness Resources for information and resources on how to keep you and your baby healthy. If you would like to receive pregnancy information by mail, please call Member Services at the number on your member ID card.
You can access education, including: • Self-care information about your pregnancy. • Healthy Rewards program information on how to redeem your incentives for prenatal, postpartum, and well-baby care. • Education on having a healthy baby, postpartum depression, and caring for your newborn, with helpful resources. While you are pregnant, you need to take good care of your health. You may be able to get healthy food from the Women, Infants, and Children (WIC) program. Member Services can give you the phone number for the WIC program close to you. When you are pregnant, you must go to your PMP or OB-GYN at least: • Every four weeks for the first six months. • Every two weeks for the seventh and eighth months. • Every week during the last month. Your PMP or OB-GYN may want you to visit more than this based on your health needs. When you have a new baby When you deliver your baby, you and your baby may stay in the hospital at least: • 48 hours after a vaginal delivery. • 72 hours after a Cesarean section (C-section). You may stay in the hospital for less time if your PMP or OB-GYN and the baby’s provider see that you and your baby are doing well. If you and your baby leave the hospital early, your PMP or OB-GYN may ask you to have an office or in-home nurse visit within 48 hours. 26

After you have your baby: • You must call Anthem Member Services at 866-408-6131 (TTY 711) as soon as you can. We will need some information. • You must call the Indiana Family and Social Services Administration at 800-403-0864 to report the birth. It’s important to set up a visit with your PMP or OB-GYN after you have your baby for a postpartum checkup. You may feel well and think you are healing, but it takes the body at least six weeks to mend after delivery. • The visit should be done between 7 to 84 days after you deliver. • If you delivered by C-section or had complications with your pregnancy or delivery, your PMP or OB-GYN may ask you to come back for a one- or two-week checkup. This is not considered a postpartum checkup. You will still need to go back and see your provider within 7 to 84 days after your delivery for your postpartum checkup. It’s also important to schedule a well-baby visit for your baby. Your baby’s PMP can provide the best care by working closely with you. For the first years of life, the American Academy of Pediatricians suggests that your baby have a checkup at birth; at 3 to 5 days old; and at 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months. At these visits, your baby’s doctor will make sure your baby is getting all the care your baby needs, including well-checks, vaccines, and other care suggested by the Bright Futures EPSDT coverage recommendations. Prenatal rewards If you’re pregnant, you could be rewarded for getting the needed prenatal and postpartum care for you and your baby. To learn more, visit anthem.com/ AnthemRewards or call Member Services toll free at 866-408-6131 (TTY 711) to receive information on our prenatal rewards.
CenteringPregnancy® CenteringPregnancy is a peer support group, offering individuals a place to share their feelings and concerns during their pregnancy. A group facilitator guides the discussion and introduces new points of view. Baby shower program Anthem partners with groups, such as WIC, to host baby showers around the state to educate pregnant individuals about their babies. Participants will learn about the importance of well-baby visits, how to select a doctor, scheduling appointments, and much more. Baby & Me - Tobacco Free Program™ (BMTF) This smoking-cessation program aims to lower the tobacco use of pregnant members. Those who follow these four steps will be eligible for rewards, such as $25 diaper vouchers:

Enroll in the program.
Take prenatal smoking-cessation classes.
Agree to take a monthly breath test.
Stay smoke-free after their baby is born. 27

Go to babyandmetobaccofree.org to find out more.
For more information about our prenatal programs, call Member Services at 866-408-6131 (TTY 711). Quit Now Indiana When you’re ready to quit, just call the Indiana Tobacco Quitline at 800-QUIT-NOW or 800-784-8669 for more information. This service is free for all Indiana residents to help smokers quit. Call Member Services at 866-408-6131 (TTY 711) to find out more about signing up for the Quit Now Indiana. If you’re pregnant, you may be able to earn rewards. Your HIP POWER Account With HIP Plus, every member has a savings account called a Personal Wellness and Responsibility Account. It’s called the POWER Account for short. This POWER Account has $2,500 in it. You use this money to pay for your approved healthcare within the Healthy Indiana Plan. Where does the money in my POWER Account come from? If you’re in the HIP Plus plan, the state pays for most of the $2,500 in the POWER Account, and you must make payments towards your part of the POWER Account. These payments are called contributions and are based on your income. You will get a bill each month for the payment you need to make. Please remember to pay your POWER Account in full every month. No other payments are needed, except if you use the ER for a nonemergency situation. Then, you would pay a copay of $8. If you’re in HIP Basic, the state pays all of the $2,500 in the POWER Account and you don’t pay a monthly contribution. But, you pay a copay each time you go to the doctor, have a hospital visit, or get prescriptions. These copays range between $4 and $75 and can cost more when compared to a low monthly payment with HIP Plus. HIP Basic has fewer benefits than HIP Plus as it does not cover vision, dental, and chiropractic care. Your POWER Account contribution HIP Plus members make a monthly payment called a contribution. This POWER Account contribution, or PAC, is based on your income. So, the more you make, the more your PAC will be. See the PAC tiers table below to find the monthly PAC amounts. Tobacco surcharge If you use tobacco, you have the first 12 months of your HIP plan to stop using tobacco. If you don’t, you’ll have a higher PAC after the first 12 months. Your PAC payment will have a 50% fee added. See the PAC tiers table to find the monthly PAC amounts with the tobacco surcharge added. 28

Tobacco use includes these products: • Chewing tobacco • Cigarettes • Cigars • Pipes • Hookah • Snuff We have programs and benefits to help you quit smoking. And you can even earn money for quitting. See the section Services offered by Anthem in this handbook to learn more. When you start your first 12-month HIP benefits year, you’ll have a chance to tell us if you do or do not use tobacco. If you stop using tobacco, you can let us know anytime by calling: • The enrollment broker at 877-GET-HIP-9 (877-438-4479). • Member Services at866-408-6131 (TTY 711). If you are listed as a tobacco user, and you think it is wrong, you can file an appeal with us to tell us why you think it’s wrong. See Part 6 How to resolve a problem with Anthem in this handbook to find out how to do this. PAC tiers table Federal Poverty Level tiers Monthly PAC member Monthly PAC spouse Monthly PAC member with tobacco surcharge Monthly PAC - one tobacco surcharge Monthly PAC

two tobacco surcharges Up to 22% $1.00 $1.00 $1.50 $1.00 & $1.50 $1.50 23%–50% $5.00 $2.50 $7.50 $2.50 & $3.75 $3.75 51%–75% $10.00 $5.00 $15.00 $5.00 & $7.50 $7.50 76%–100% $15.00 $7.50 $22.50 $7.50 & $11.25 $11.25 101%–138% $20.00 $10.00 $30.00 $10.00 & $15.00 $15.00 What happens if you don’t pay on time? If we don’t receive your POWER Account contribution within 60 days of when it’s due, these changes will happen: • If you’re considered to be medically frail, you’ll be moved to HIP State Plan Basic. You’ll have copays ranging from $4 to $75. • If you are not medically frail, you may lose your coverage. Five percent cost-sharing limit Each benefit quarter (or three months), you should not pay more than 5% of your household’s income to your POWER Account and any copays. Anthem will track your payments. If we find you have met your 5% limit, your PAC invoice will be set to $1, or 29

$1.50 for tobacco users, which you are still expected to pay. Your regular contribution amount and copays will start again at the beginning of the next quarter.
However, if you feel you’ve paid more than 5% of your family’s income for the quarter on healthcare, call us immediately at Member Services at 866-408-6131 (TTY 711). You’ll need to show written proof of the amount you paid. If your income, household size, or contact information changes As a HIP member, you must report these changes within 10 days of when the change occurs: • You move to a new address or change mailing addresses. • Your family income or family size changes. • You lose your job, change jobs, or get a new job. • You become pregnant, deliver your baby, or when your pregnancy ends. • You become insured under Medicare or another type of insurance. • Any other change that you think may affect your eligibility or benefits for HIP. To make these updates: • Go to FSSABenefits.in.gov. • Select Sign in or Create account and follow the prompts. • Call Member Services at 866-408-6131 (TTY 711) if you need assistance. How to make a payment to your POWER Account As a HIP Plus member, you must make monthly payments to your POWER Account, called contributions. You’ll get a letter from us each month, called an invoice. Here are the ways you can make your payment. 1) Online through your bank: Talk to your bank if you need help signing up for their online bill pay services. Allow three business days for your payment to post. 2) Online through Anthem’s secure member portal at member.anthem.com/public/login. 3) Pay by mail: Send the POWER Account invoice form with your check or money order to: Anthem Blue Cross Blue Shield P.O. Box 6431 Carol Stream, IL 60197-6431 Be sure to write your member ID number on your payment. Be sure to mail payments with the tear-off coupon attached to your invoice and be sure to include the tear-off coupon from your invoice in the envelope with your payment. If you are paying for multiple family members with one check, include all the coupons and member IDs. 4) Pay by MoneyGram: Go to any MoneyGram location. You can ﬁnd them at places like Walmart or CVS. A complete list is online at moneygram.com. You’ll need your member ID number, which is located on the front of your ID card; the company name, Anthem Healthy Indiana Plan; enough cash for your payment; 30

and/or the ﬁve-digit Receive Code, 15204. Be sure to take the payment slip attached to your invoice with you. Complete the MoneyGram ExpressPayment® blue form and use the red MoneyGram phone or the MoneyGram kiosk to complete your transaction. (Payment processes may vary depending on your location. Simply ask an associate for help.) There is no charge for this service. 5) Pay by phone: Payments can be made using a credit card by calling Member Services at 866-408-6131 (TTY 711). Allow at least ﬁve days for your payment to post. 6) Pay by employer/nonproﬁt contributions: An employer or a nonproﬁt group, like a church or foundation, can pay some or all of your contribution. If they pay a part of your contribution, you pay what is left. Employers and nonproﬁt groups can visit anthem.com/Pay4HIP to learn more. 7) IVR: Our members can call and make payments via the voice response system without speaking to a customer service representative.
8) Mobile: Our members can make payments via mobile devices using a portal called QuickPay or in the Sydney Health app. To access QuickPay, use the labeled QR code or visit payment.anthem.com/billpay/payment#/medicaid. To download the Sydney Health app, scan the labeled QR code or visit sydneyhealth.com. QuickPay Sydney Health 9) Recurring bank draft: Payments may be taken from your checking or savings account each month. To request a setup form, contact Member Services at 866-408-6131 (TTY 711). Easy ways to pay your HIP Plus POWER Account Bank draft Online Telephone Have payments taken from your account. Register at anthem.com/inmedicaid. Or, pay online through your bank. Call Member Services at 866-408-6131 (TTY 711). Allow five days to post to your account. MoneyGram Mail Contributions To make a cash payment, just go to any MoneyGram location. Anthem Blue Cross and
Blue Shield
P.O. Box 6431
Carol Stream, IL 60197- 6431
From your employer or a nonprofit group. 31

What if I don’t pay my POWER Account? If your POWER Account is more than 60 days past due, you could lose some or all of your benefits. Keep your benefits by paying on time. POWER Account rollover credit The money you pay into your POWER Account will be yours. If there is money left in the account at the end of the year, you can use this money to lower what you owe if you continue in HIP. HIP Plus members If you get certain preventive care services, you may qualify to double the amount of your POWER Account Contribution (PAC) money left over. This is called a rollover credit. So, if your portion of money left over at the end of your benefit year is $10, getting the required preventive care can save you up to $20 in what you pay the following year. (Note: The amount of your rollover cannot be greater than what you paid in.)
HIP Basic members If you get your preventive care, you may be able to move up to HIP Plus at a discount when you are determined eligible for another benefit period and continue in HIP. The discount reduces your monthly POWER Account contribution in your current benefit period and your monthly contribution payments could be lowered in HIP Plus by up to 50%. Will I be charged for preventive services? No. You get these benefits at no cost to you. Preventive care helps you improve your health, and it can help you manage your POWER Account and save money. By getting no-cost preventive care and staying healthy, you may be able to: • Use your POWER Account less. • Qualify to have leftover funds roll over and reduce the following year’s PAC. • Save money on your healthcare. See the Preventive Care section for a list of preventive care services. Monthly POWER Account statement You will receive a POWER Account statement every month, and it will serve as your explanation of benefits (EOB). It’s not a bill. You can also go to anthem.com/inmedicaid or our mobile app and log in to view your statement.
The statement includes: • The amount you have contributed to your account. • The amount the state has contributed to your account. • All the claims we have paid. • The balance in your POWER Account. • Which claims were paid from POWER Account funds. 32

Anthem provides members with an up-to-date provider directory to help you find a provider that is in the Anthem network. The directory can be found on anthem.com/inmedicaid and is ready for you to search based on your healthcare needs. Our provider directory tells you all about the doctors in your plan, including:

Part 2 – Ways to great health How to choose your PMP Now that you have selected Anthem, the next step is choosing a primary medical provider (PMP). Your PMP is the first person you call for all your healthcare needs. They will help you at any time, even after hours, and will respect your cultural and religious beliefs. Your PMP will take care of all your healthcare needs by coordinating: • Checkups and vaccines. • Requests to get an OK to give you services if needed. • Referrals to specialists. • Referrals for tests and services. • Admission to a hospital. Your PMP can be a/an: • Family physician or general practitioner (a doctor who treats people of all ages). • Internist (a doctor who treats adults). • Obstetrician/gynecologist (a doctor who takes care the female reproductive system). • Clinic doctor (at a health department, health center, or rural health clinic). • Advanced practice provider, including a nurse practitioner or physician assistant. • An endocrinologist (if primarily engaged in internal medicine). To select a doctor, or PMP, you can: • Go to anthem.com/inmedicaid and select Find a Provider. • Call Member Services at 866-408-6131 (TTY 711). • You can request a paper copy of Anthem’s Provider Directory to find and choose a PMP. Provider directory • Names, addresses, phone numbers, and office hours. • Gender. • Specialties. • Languages they speak. • Hospitals they work in. • If they take new patients. • Where they are located (using an online map). • Medical school and residency completion. • Professional achievements. • Board-certification status. 33

If you need a Provider Directory or help choosing a doctor who is right for you, visit anthem.com/inmedicaid or call Member Services at 866-408-6131 (TTY 711).

How to change your PMP It is best to keep the same PMP. They know your health needs. If you choose to see a doctor who is not your PMP and you did not get an OK from us first, you may have to pay for the services. If you want to change your PMP, you can quickly do it online at anthem.com/inmedicaid and by logging in to the secure member website or through the Sydney Health mobile app. Log in to access your secure account and change your PMP. If you don’t have a secure account, you can create one at any time by selecting Register now. You’ll need your member ID number located on your member ID card. We can also help you change your PMP over the phone by calling Member Services at 866-408-6131 (TTY 711). American Indian/Alaska Native (AI/AN) process to opt out of managed care You have a choice to receive traditional Medicaid benefits instead of HIP. You can call the Healthy Indiana Plan Helpline at 877-438-4479 (TTY 711) for questions about changing your health plan. It won’t cost anything to change, and you could receive more benefits from traditional Medicaid than from HIP. AI/AN Anthem members can receive services from an Indian healthcare provider, including in- and out-of-state providers. Indian healthcare providers include providers operated by: • Indian Health Service (IHS). • Tribal organization. • Urban Indian organization. • An Indian tribe. Also, if an Indian healthcare provider is in the Anthem plan, you can choose that provider as your PMP. Changing your PMP Member Services can assist you in finding your new PMP when: • You have moved. • Your doctor has moved or no longer belongs to Anthem. • You are not happy with the care you are receiving from your PMP. • Someone in your PMP’s office treated you rudely. • Your doctor does not return your calls. • You have trouble getting the care you want, or your PMP says you need. Call Member Services at 866-408-6131 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. Eastern time. 34

Health plan network updates Anthem will publish any updates to the provider network no less than 30 days prior to the effective date of the change. This means if there is a change that could impact your care, the health plan will provide the information to you within 30 business days. How to access care A PMP is a primary medical provider. Your PMP is your health partner. You will call them first when you need healthcare. They will work with you on all your healthcare needs. Your PMP will usually be able to help you with whatever you need. If your PMP is unable to treat your health issue, they will refer you to another place to get care. Seeing a specialist Your PMP may send you to a specialist for special care or treatment. They will help choose a specialist to give you the care you need. You may need permission from Anthem to see a specialist or receive certain care. Your PMP knows when to ask for permission. Your PMP’s office staff can help you get an appointment with a specialist. Make sure to tell your PMP and specialist as much about your health as you can. If your specialist or any other provider is not in the Anthem provider network, they must get permission from Anthem before they can give you care. You may also need a referral from your PMP. If you have questions about care your doctor says you need, you may want a second opinion to make sure the treatment plan is right for you. To get a second opinion, talk to your PMP or call Member Services at 866-408-6131 (TTY 711). Standing referral Anthem sometimes lets members get what’s called a standing referral. This means if you need special care or ongoing treatment, you can keep seeing the same specialist. Your doctor will make this referral. The treatment given by the specialist must be right for your health issues and needs. To learn more about this, call Member Services at 866-408-6131 (TTY 711). Receiving a second opinion If you have questions about care your doctor says you need, you may want a second opinion to make sure the treatment plan is right for you. To get a second opinion, talk to your PMP or call Member Services at 866-408-6131 (TTY 711). How to make a doctor’s appointment To make an appointment, call your PMP’s office and request one. Make sure to have your member ID card in your hand when you call. Tell them you are an HIP member and give them your member ID card information. When you see your PMP, they will help you understand your medical needs. At your first appointment, your PMP will: • Ask you questions about your current health and your medical history. • Give you information on how to maintain your health. • Schedule any tests and preventive care services you need. 35

Prepare for your doctor’s visit • Decide what you want to talk about and write down your questions or concerns. • Be prepared to talk about your and your family’s health history. • Bring a list of any medications you’re taking or bring them with you. • Check your current medications and make sure you’re taking them correctly. Are there other times I should visit my PMP? You should visit your doctor once a year for a checkup — even if you don’t feel sick. To help you remember, schedule your checkup in the same month as your birthday each year. Out-of-network care We contract with doctors to provide the care covered by your plan. Call your PMP or Member Services to ﬁnd out if you need preapproval before seeing a doctor who isn’t in your plan. You can also call us or visit our portal to ﬁnd a doctor in your plan. You may be able to see this out-of-plan doctor for a self-referral service. See Self-referral services below for more details. Anthem does not pay for costs from out-of-plan doctors in most cases. We can only give preapproval for those who are part of the Indiana Health Care Programs (IHCP), which means they are part of the state’s plan. There are a few other situations in addition to self-referral care where we will pay for out-of-plan services. These situations include: • Services for which you had preapproval from your previous health insurer. We will honor those preapprovals (sometimes called authorizations) for at least 90 days after you join our plan. • If you are pregnant and join our health plan in your third trimester, we will allow you to continue to see your existing providers regardless of their contract status. • If your PMP leaves our plan, you may continue to see them while we work with you to ﬁnd a new PMP within our plan. In the unlikely event that we have not contracted with a provider who offers the services you need within 60 miles of your home, we will work with you to ﬁnd a provider, even if that provider is out of plan. If you get a service from a doctor who is not in our plan or the service is not approved, it will be considered an out-of-plan service. This doesn’t apply to some self-referral services. Services from providers who are not in the Anthem plan Call your PMP or Member Services to find out if you need an OK from a provider who is not in your plan. We can only give an OK for providers who are part of the Indiana Health Coverage Programs (IHCP), which means they are part of the state’s plan. If you get a service from a doctor who is not in our plan or the service is not approved, it will be considered an out-of-plan service. This doesn’t apply to some self-referral services. You may be able to see a doctor who is not in our plan for self-referral (See the Self-referral services for more details.) 36

Continuity of care We’re here to help new members get continuing care and coordination of medically necessary services when they join Anthem. This means we will help you if you are transitioning between plans, if you are pregnant, or if you are receiving certain services, such as for HIV, hepatitis C, and/or behavioral health. If you want to know if continuity of care is for you, call Member Services at 866-408-6131 (TTY 711). Changing from pediatric care to adult care Did you know you can switch doctors when you get older? If you were an adolescent and reached adulthood, you can switch from your current pediatrician (child doctor) to a provider who cares for adults. We’ll be happy to help you choose a provider for adults. We can also help you transfer your medical records. Please call Member Services at 866-408-6131 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. Eastern time. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) We offer EPSDT services for those up to 21 years of age, including members ages 19 and 20 enrolled in any HIP product. You or your family member may improve your health if you: • Go to your PMP for routine visits and vaccines (shots). • Go to your dentist and eye doctor for checkups. Indiana Right Choices program If you’re enrolled in this program, we’ll send you a letter to let you know. A team of experts will help you get the right healthcare at the right time, in the right place. Your team will be made up of a PMP, a pharmacy, and a care manager. If you have questions about the Right Choices Program, call Member Services at 866-408-6131 (TTY 711). Enhanced beneﬁts In addition to your HIP benefits, and many doctors to choose from, Anthem offers you these extras: Enhanced benefits Details Essentials for expectant parents • New parent product toolkit • Online learning courses on pregnancy, postnatal care, and new baby care OB telehealth kits • Kit to help pregnant members to obtain accurate vital readings at home. Healthy Adults Healthy Results • Online fitness program and resources • Gym membership and home fitness kit • WW® membership for up to 13 weeks • HIP Plus and Maternity plans only Healthy meals • Healthy meals delivered to your home • HIP Plus and Maternity plans only 37

Fresh Fruits and Veggies Program • One produce box per month for three months delivered to your home • For pregnant or nursing members up to six weeks postpartum Personal care essentials • Up to $25 per member per year for health and wellness products • HIP Plus and Maternity plans only High school equivalency (HSE) assistance • Voucher(s) to cover high school equivalency test costs • HIP Plus and Maternity plans only Employment support • Personalized support from a dedicated Goodwill Guide for education, employment, and ﬁnancial literacy resources • HIP Plus and Maternity plans only Asthma and chronic obstructive pulmonary disease (COPD) relief product • Select one asthma or COPD relief product annually • HIP Plus and Maternity plans only Nonpharmacologic pain management • Up to $50 for pain management devices annually • HIP Plus and Maternity plans only Community Resource Link Online tool to help you find community-based resources in your area that support health and well-being. Transportation essentials Eligible HIP State Plan Plus, HIP Regular Plan Plus, and HIP Maternity Plan members receive unlimited trips to Women, Infants and Children (WIC) appointments, Medicaid renewal appointments, CHANGE Committee meetings, health education programs, and high school equivalency testing. To assist members in accessing community services and supports and employment opportunities, these members may also choose one of the following each year: • $25 gas card • $25 rideshare gift card • $25 in bus passes Smartphone Member Connect Support and guidance on getting a smartphone and plan to stay in touch with family, friends, doctors, and social services. Some beneﬁts are limited to certain members only, and you may need to complete certain activities to be eligible. Beneﬁts may change or end at any time. Go to anthem.com/inmedicaid to learn more. 38

Healthy Rewards for getting and staying healthy At Anthem, we want you to be as healthy as you can be. Great health starts with preventive care. Preventive care may include any needed exams, screenings, or vaccinations. It is the care you get when you are not sick, so your doctor can help you before you get sick. Your health is so important, we want to reward you for taking care of it. There are many types of care you can get to earn incentives through our Healthy Rewards program. Talk with your doctor about preventive care that is right for you. We will send you texts and emails to let you know which incentives apply to you. The ﬁrst reward is for completing the Health Needs Screening (HNS) within 90 days of joining. You can complete the HNS with your care coordinator and earn your rewards. New Anthem members will receive more details about completing the HNS and other healthy activities. Go to anthem.com/AnthemRewards to ﬁnd out what other rewards you may be able to earn.
Healthy Rewards program rules • Medicaid must be your primary insurance. • You must be an eligible Anthem member at the time the reward is used. If there is a lapse in your coverage after earning the reward, you will not be eligible to use the reward. • Your Healthy Rewards may only be used at participating retailers. The purchase of alcohol, tobacco, e-cigarettes, ﬁrearms, or prescription drugs is not allowed. • You must have a valid email address. How to start earning Healthy Rewards Register by logging in to the Beneﬁt Reward Hub on the secure member website to redeem your Healthy Rewards and view the rewards you are eligible for. You can also access your Healthy Rewards through the My Health Dashboard section of Sydney Health, our mobile app. Or, call the Healthy Rewards customer service line at 888-990-8681 (TTY 711). For more information about these programs, contact your care coordinator or call Member Services at 866-408-6131 (TTY 711). Blue Ticket to Health Anthem has teamed up with the Indianapolis Colts to help members ages 3 and up stay healthy. To take part, call your doctor to set up a wellness checkup. Call your provider to schedule an appointment today and enter to win. Once you have your annual wellness and dental checkup, you will be automatically entered into Blue Ticket to Health for a chance to win one of many prizes. For program rules and guidelines, go to anthem.com/blueticket. 39

It’s important to see the doctor each year for wellness checkups, even when you’re not sick. It helps the doctor ﬁnd any health problems early. If you need help making an appointment with your doctor or dentist, we can help. Call Member Services at
866-408-6131 (TTY 711).
Community Resource Link We provide you with access to online resource tools, like the Community Resource Link, to help you ﬁnd and apply for community and social services in Indiana. Find these services in your area by visiting anthem.com/inmedicaid.
Preventive Care Seeing your doctor for preventive care is very important. Preventive care includes medical services you use to check your health to prevent and catch early symptoms of illness. It helps keep you healthy, especially as you get older. Immunizations are shots that protect the body from disease and illness. Some immunizations require follow-up shots, or “boosters.” These shots are given to you at certain times and are needed to prevent disease and help you maintain your health. If you’re not sure if you have all your recommended shots, talk to your doctor right away.
For more information about vaccines, visit cdc.gov/vaccines. All preventive care is paid for by Anthem. You are encouraged to use all preventive care services. See the chart below for preventive care services and immunizations for adult men and women. Preventive service Age
Annual physical 19+ Flu shot 19+ Vision 19+ Dental 19+ Mammogram 40+ Pap smear 21+, every 3 years Cholesterol testing 20+, every 5 years Diabetes screen 35+ Tetanus, diphtheria, pertussis (Tdap) vaccine 20+, every 10 years Colorectal cancer (CRC) screening 45+, every 10 years Abdominal aortic aneurysm (AAA) screening 65+ if ever a smoker, once Prostate cancer screening** 55+

These are general guidelines and may change upon clinical recommendations from your primary medical provider (PMP).
** The decision to test for prostate cancer should be an individual one, and if done, future screening guidelines depend on the results of the initial test and clinical guidance from your primary medical provider (PMP).
For more information about vaccines, visit cdc.gov/vaccines.
40

Stay well Each person has special needs at every stage of life. We have programs to help you stay healthy and manage illness. These programs are at no cost to you. For all adults • Annual checkups and screenings such as body mass index (BMI), blood pressure, and diabetes • Immunizations such as tetanus and the flu can keep you well • Testing for sexually transmitted infections (STIs) such as HIV/AIDS For women • Services for women such as mammograms and cervical cancer screenings • Pregnancy and childbirth classes to help you stay healthy while you’re pregnant • Family services to help with a healthy pregnancy, preventing pregnancy, or preventing sexually transmitted infections (STIs) such as HIV/AIDS For men • Screenings in certain men for prostate cancer and abdominal aortic aneurysm You can find Preventive Health Guidelines with helpful ways to stay healthy on our website at anthem.com/inmedicaid. We also offer information on specific health- related topics, the importance of preventive care, and how to navigate the healthcare system on our website at anthem.com/inmedicaid under Member Materials.
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) We offer EPSDT services for those up to 21 years of age, including members ages 19 and 20 enrolled in any HIP product. You or your family member can be healthy if you: • Go to your PMP for routine visits and vaccines (shots). • Go to your dentist and eye doctor for checkups. When and where to go for care It is important to know when and where to go for the medical care you need. Sometimes, it may seem difficult to decide where you should go when you or a family member doesn’t feel well. Anthem has many options for care. The chart below shows some options for care and when they are the best option for you to use. Primary medical provider (PMP) Check-ups and physicals; immunizations; minor aches and pains Telehealth For minor problems when you cannot see your PMP in office. Telehealth is seeing your doctor remotely, usually by a video or audio call on your phone. Convenience care clinic For minor problems when your PMP is unavailable. 41

Urgent care For problems that could become emergencies if left untreated for 24 hours. If you have an injury that could turn into an emergency if not treated within 24 hours, you need urgent care. Call your PMP or 24/7 NurseLine at 866-408-6131 (TTY 711) if you have questions. Emergency room (ER) Life-threatening emergencies Access to care The chart below helps you understand when you can expect to get an appointment with your provider. Provider type Appointment category Appointment standards PMP Routine Within 30 calendar days Urgent Within 48 hours Emergency 24 hours a day, seven days a week Routine gynecological exam/new patient Within 30 calendar days Annual physical exam Within 90 calendar days Specialist Routine Within 60 calendar days Urgent Within 48 hours Emergency 24 hours a day, seven days a week Behavioral health Nonlife-threatening emergency Within six hours Urgent Within 48 hours Emergency 24 hours a day, seven days a week Initial visit for routine care Within 10 business days Follow-up routine care Within 30 calendar days based off the condition Outpatient follow-up appointment Within seven days following discharge for the inpatient behavior health hospitalization 24/7 NurseLine 24/7 NurseLine is a 24-hour, seven-days-a-week phone service staffed by specially trained registered nurses. Interpreter services are available 24 hours a day, seven days a week for non-English speakers. 42

Access to 24/7 NurseLine allows members to access health services/education, optimize utilization, and refer to community-based health services. The 24/7 NurseLine can also help members decide if an emergency room visit is needed. 24/7 NurseLine includes: • Direct access to a registered nurse who can answer questions about your health concerns, medical conditions, prescription drugs, and local healthcare services. • Notifications to let your providers know of a clinical contact with 24/7 NurseLine. 24/7 NurseLine contact reporting is available to Anthem for referral to care and service coordinators. After-hours care Primary medical provider (PMP) after-hours coverage is available to you 24 hours a day, seven days a week. Healthy Indiana Plan maintains standards your PMP must follow. Your PMP or designated provider will answer your phone call after normal business hours in English and Spanish. After-hours coverage for your PMP may include an answering service or a shared-call service with other medical providers. An urgent medical condition is not an emergency but needs medical care within 24 hours. It’s not the same as a true emergency. Call your PMP if your condition is urgent, and you need medical help within 24 hours. If you cannot reach your PMP, call 24/7 NurseLine, even on holidays, at 866-408-6131 (TTY 711). Urgent care If you have an injury that could turn into an emergency if not treated within 24 hours, you need urgent care. Call your PMP or 24/7 NurseLine at 866-408-6131 (TTY 711) if you have questions. Urgent care symptoms include: • Cold, flu, or sore throat • Earache • Vomiting or diarrhea • Common sprain • Minor broken bone • Minor cuts • Mild asthma/allergic reactions • Rash without fever Emergency services An emergency is a medical condition with severe symptoms that may be life- threatening or cause serious damage to you. Examples of health problems needing emergency treatment include: • Uncontrolled bleeding, major burns, seizures/convulsions. • Fainting, shortness of breath, severe chest pain, severe vomiting. • Cases of rape or molestation. • Poisoning. • A serious accident. 43

• Broken bones. If you have an emergency, call 911 or go to the nearest ER. Do not call Anthem prior to calling 911. You have the right to use any hospital or other setting for emergency care. Emergency room (ER) visits do not require prior approval for emergency services or post-stabilization care. Make sure to call your PMP within 24 hours after you go to the ER or if you’ve checked into the hospital. Your PMP will set up a visit with you for follow-up care. If you are experiencing a mental health crisis, call 988 for the National Suicide & Crisis Lifeline, or call 833-874-0016 (TTY 711) for the Anthem Behavioral Health Crisis Hotline. Clinicians are available 24 hours a day, seven days a week to talk with you. Receiving emergency care outside our service area If you need emergency care while you’re traveling outside of our service area, follow these steps to help make sure you’re covered: • Call your PMP (or have the hospital call your PMP) if you need surgery, admission to the hospital, or any other services after you’re stable. • Show your ID card to the hospital or doctor. • HIP does not cover services provided outside the U.S. If you are not sure if you are having an emergency, please call your PMP. If you cannot reach your PMP’s office, you can call 24/7 NurseLine at 866-408-6131 (TTY 711). The nurse can help you: • Decide if you need to see your doctor. • Decide if you should go to the emergency room. • Answer general questions about your health. What is post-stabilization care? This is the care you get in the ER or hospital after your condition is stable. Your doctor will examine you to make sure you’re well enough to leave. 44

What if I receive a bill from my doctor? In most cases, you should not get a bill from a provider. But you may have to pay charges if: • You agreed in writing ahead of time to pay for care that is not offered by Anthem after you asked for an OK from us. • You agreed ahead of time in writing to pay for care from a provider who does not work with us, and you did not get our OK ahead of time. If you get a bill and you do not think you should have to pay for the charges, call Member Services at 866-408-6131 (TTY 711). Have the bill with you when you call and tell us: • The date of service. • The amount being charged. • Why you’re being billed. Transportation HIP State Plans include transportation (ride) benefits. Eligible HIP Plus members may also qualify. Rides to the locations listed below are included in the HIP plan through Anthem: • Any doctor visit or healthcare appointment • Your pharmacy on the return from the doctor • Discharge from an inpatient hospital stay • WIC and benefit renewal appointments • Health education programs • Member advisory committee meetings Please schedule a ride at least two business days before your appointment. Remember, if you have an emergency, please call 911 or go directly to the nearest emergency room. If you have questions, please call Member Services at 866-408-6131 (TTY 711). When you need a ride, follow these steps: 1) Schedule your ride. Call Anthem Transportation Services at 844-772-6632 (TTY 888-238-9816) or book online at passengerportal.welltransnemt.com at least two full business days or as many as 45 days in advance. • Calls for routine reservations are accepted Monday through Friday from 8 a.m. to 8 p.m. Eastern time. • Calls for urgent and same-day reservations are accepted 24/7. • Calls for cancellations, status updates, and hospital discharges are accepted 24/7. 2) Set up your ride. When you call, tell them your member ID number on your member ID card or date of birth, the date and time of your appointment, and if you need extra help, such as a wheelchair. 3) Book your return trip. When your appointment is over, call Anthem Transportation Services. After you get care, ask the medical office to call the ride company for your return trip home. If you need to have a prescription filled at the office before leaving, work with 45

your doctor to do so before calling your driver for the trip home. Your driver will need to be told about a stop at the pharmacy when scheduling the trip home. When using ride services, please follow these rules: • Wait for the driver at the curbside pick-up and drop-off site. The driver is only allowed to wait 15 minutes. If they wait too long, they will leave, and you will not be able to get a ride. • If you must cancel your ride, you must call at least two hours before your set pick-up time. Anthem Transportation Services can help you find out what transportation options are available in your area. Call Member Services at 866-408-6131 (TTY 711) to find out about: • Pick-up and drop-off services. • Gas and mileage reimbursement. • Long-distance trips. Riders must follow state and local laws. This includes wearing seat belts and ensuring minor children are properly secured. Adults are responsible for providing the child’s safety seat. If your plans change, call Anthem Transportation Services as soon as possible, so the transportation provider can be informed. Rides are only provided to members who do not have other transportation. If you have reliable transportation, access to public transportation, or family and friends who can drive you, you must use these options first. Transportation phone number: 844-772-6632 (TTY 888-238-9816) Behavioral health and substance use disorder Behavioral health is about how you feel and act. It is also called mental health. Your mental health is very important. All HIP members can receive mental health and substance use disorder services. You may see any in-network doctor without a referral for outpatient treatment. If you are having thoughts about hurting yourself or someone else, call 988 immediately for help. If you have questions, please call Anthem’s helpline below. We cover care for mental health and substance use disorders for all HIP members. You do not need a referral from your PMP to see someone for these services. Anthem Member Services can help you ﬁnd a provider in your area. We cover: • Inpatient services in a hospital. • Partial hospitalization. • Intensive outpatient program. • Individual, family, and group therapy. • Medication services. • Psychological testing. 46

• Community-based services. • Substance use disorder (SUD) residential treatment. • Opioid treatment programs (OTPs). • Applied behavioral analysis (ABA). • Mobile crisis services. If you or someone you know needs support now, call or text 988 or start a chat at 988lifeline.org. The 988 Suicide & Crisis Lifeline connects you with a trained crisis counselor who can help. If you have questions about behavioral health services, call Anthem at: Member Services: 866-408-6131 (TTY 711) 47

Part 3 – Pharmacy services Pharmacy information Anthem covers medicines you need. You can go to any pharmacy that accepts Anthem. Prescription drugs, including injections and infusions, certain over-the-counter drugs, and pharmacy supplements, are benefits under the HIP program. Filling your prescriptions • Your doctor will write you a prescription for medicine you may need. • Your doctor will then contact your pharmacy, or you can go there with your prescription. Anthem works with CarelonRx to manage your pharmacy benefits. • You must use a pharmacy that takes Anthem. This may include mail-order pharmacies. You can ﬁnd Anthem pharmacies in our Provider Directory or by calling Member Services at 866-408-6131 (TTY 711). • Your pharmacy beneﬁts have a Preferred Drug List (PDL). The PDL shows some of the drugs offered under the pharmacy beneﬁt. Find the complete PDL at anthem.com/inmedicaid. Pharmacy benefits for HIP members include: • Prescription drugs • Over-the-counter (OTC) items approved by the Food and Drug Administration (FDA) and listed on the OTC medication list • Self-injectable drugs (including insulin) • Needles, syringes, blood sugar monitors, test strips, lancets, and glucose urine testing strips • Drugs to help you quit smoking These prescription drugs are not offered: • Over-the-counter (OTC) medicines (unless specified on formulary or PDL list) • Drugs used to become pregnant • Experimental or investigational drugs • Drugs for cosmetic reasons • Drugs for hair growth • Drugs to treat erectile dysfunction Generic drugs Generic drugs are as good as brand-name drugs. Your pharmacist will give you generic drugs when your doctor has approved them. Here are a few things you need to know: • Generic drugs must be given when there is one available. • Brand-name drugs may be given if there is not a generic drug for it. • The PDL will tell you the exceptions to these rules. Generic and preferred drugs must be used for your condition unless your doctor gives a medical reason to use a different drug. 48

Prior authorization Some drugs need a preapproval, or an OK, ahead of time. Your doctor must ask for an OK if: • A drug is listed as nonpreferred on the PDL. • Certain conditions need to be met before you get the drug. • You’re getting more of a drug than what is normally expected. • There are other drugs that should be tried first. If an OK is needed, your doctor will need to give us details about your health. We will then decide whether Indiana Health Coverage Programs (IHCP) can pay for the drug. This is important because: • You may need tests or help with a drug. • You may be able to take a different drug. Show your ID card to your provider. It has the phone number for preapproval requests. Anthem will decide within 24 hours after getting the request (not including Sundays or some holidays) if your drug request can be approved. Your doctor will be notified. Pharmacy copays HIP members in the Basic Plan have these copays: • $4 for preferred drugs • $8 for nonpreferred drugs There is no pharmacy copay for: • HIP Plus members • HIP Maternity plan members • American Indian/Alaska Native members • Members who have spent 5% of their income for copays and/or contributions • Drugs given as an emergency supply Other things you need to know about your medication Days’ supply of drugs Members may receive a 30-day supply of non-maintenance drugs or a 90-day supply of maintenance drugs through the mail or at the drugstore. Members can have the pharmacy set up their 90-day refills for a single date so you can make one trip to the pharmacy to pick up all your medications. Early refills Your pharmacist will have to ask for an OK ahead of time if you want to get your prescription refilled early. Do not wait until you’re out of a drug to ask for a refill. Please call your doctor or pharmacy a few days before you run out of your drug. Emergency safety programs Through Emergency Safety Communications, we alert you and your doctors about significant safety-related drug recalls or market withdrawals. 49

Medication therapy management We offer a Medication Therapy Management program to HIP members who qualify. It helps make sure you get the most benefit from your drugs. Member medication support To support members who’ve recently visited the emergency room, we send surveys to gather information about your experience and reasons for the visit. If your visit was related to a medication issue, we’ll send a letter about the medications and how to appropriately take them. Your appeal rights If your drug request is denied, you or your provider can appeal this decision. If you exhaust your appeals, then you may ask for a Medicaid hearing and appeals review if IHCP or Anthem: • Denied you a service. • Reduced a service. • Ended a service that was approved before. • Failed to give you timely service. To ask for a review, you must send a letter to the Family and Social Services Administration within 120 calendar days of receiving our decision about your denial. Send your letter to: Office of Administrative Law Proceedings 100 N. Senate Ave., Room N802 Indianapolis, IN 46204 A judge will hear your case and send you a letter with the decision within 90 business days after the date that you first asked for the hearing. 50

Part 4 – Help with special services Language assistance
If English is not your main language, Anthem can provide you with an interpreter at no cost to you. To request assistance, please call Anthem Member Services. If you are deaf or hard of hearing, Anthem can provide you with an American Sign Language Interpreter at no cost to you. To request assistance, please call Member Services at 866-408-6131 (TTY 711). You can get help in your language or sign language when you go to the doctor. Anthem can give you reading materials in your preferred language or format. If you need your member handbook and other health plan information in other ways, let us know. For example, if you need the information in another language, larger print, Braille, or in audio format, call Member Services at 866-408-6131 (TTY 711). Anthem will answer your questions in your language. We offer services and programs that meet many language and cultural needs and help give you access to quality care. Our interpreter service works with more than 400 languages. We offer: • 24-hour access to telephone interpreters. • Member Services staff who are able to speak other languages. • Sign language and face-to-face interpreters. • Doctors who speak other languages. • A translator or oral interpreter (over the phone or face to face) when you are receiving healthcare services. • Health education materials translated into different languages and other formats, such as Braille, large print, or audio CD. We also help make sure oral interpretation services are available to members seeking healthcare-related services in a provider's service office. This includes ensuring providers who have 24-hour access to healthcare-related services in their service locations or via phone (e.g. hospital emergency departments, PMPs) provide members with 24-hour oral interpreter services, either through interpreters or phone services. For example, we will ensure network providers offer TDD services for hearing impaired members, oral interpreters, and signers. Tell your doctor if you need a sign language interpreter for your medical visits. Call Member Services at least 72 hours in advance if you need an interpreter or translator at your PMP’s office, other healthcare provider offices, or agencies supporting your healthcare needs. Language help 866-408-6131 (TTY 711) Hearing and speech assistance Call our toll-free Member Services line at 866-408-6131 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m. Eastern time. If you need help between 8 p.m. and 8 a.m. or on weekends, call Relay Indiana at 800-743-3333 (TTY 711). 51

Americans with Disabilities Act We meet the terms of the Americans with Disabilities Act (ADA) of 1990. This act protects you from discrimination by us because of a disability. If you believe you have been treated differently because of a disability, please call Member Services toll free at 866-408-6131 (TTY 711). Redetermination To continue receiving health coverage, you must renew your benefits. This is called a redetermination. Depending on your income at the end of each year of your coverage, you may have to show you are still eligible. Prior to your health coverage ending, a letter will be mailed to you from the Family and Social Services Administration (FSSA). The letter is called a “.Eligibility Notice for Health Coverage.” Be sure to carefully read the directions that come with your renewal form. You may be required to sign the form and return it with some information. Contact the Division of Family Resources (DFR) at 800-403-0864 to ask questions. It can take about 45 days to complete your redetermination process. You will receive a notice from the DFR and Anthem to remind you about the redetermination. Anthem can assist you in the redetermination process. However, it is important to keep your address and phone number updated so you receive notices. If your phone number or address changes, contact the DFR online at fssabenefits.in.gov, or call
800-403-0864.
Division of Family Resources (DFR) toll-free line: 800-403-0864 8 a.m. -4:30 p.m. local time If you have other insurance Call us at 866-408-6131 (TTY 711) if you have other health benefits. This helps us work with your other insurance company to correctly pay claims. Also call us if you: • Have a workers’ compensation claim. • Are waiting for a decision on a personal injury or medical malpractice lawsuit. • Have a car accident. • Become eligible for Medicare. In some cases, Anthem may have the right to get back payments they made for you if another insurance company made payments for your healthcare. Let us know right away if you were hurt in an accident or if another company made payments for your healthcare. You’ll need to let us know information about what happened. Call the Subrogation department at 866-891-7397 (TTY 711). Manage your benefits Another option to report any changes is through the FSSA Benefits Portal. FSSA has developed an online tool that will allow you to manage your benefits, report changes, print proof of eligibility, and view your notices/correspondence. The Benefits Portal can be found at fssabenefits.in.gov/bp/#. 52

Your Benefit Year — mark your calendar During the Health Plan Selection Period between November 1 and December 15, you’ll have the chance to pick the health plan you’ll stay with all year, from January through December. This is called your Benefit Year. You’ll stay with the same health plan all year, even if you leave HIP and come back during the year. If you do not pick a new plan, you will be automatically reenrolled as long as you are still eligible. The good news is, if you like Anthem, you don’t have to do anything. You will be automatically reenrolled with us for next year. If you want to make a change, you can call the enrollment broker at 877-GET-HIP-9 (877-438-4479) between November 1 and December 15 to let them know you want to pick a new health plan for the next Benefit Year. If you were unable to take part in this health plan selection period because you were in a different program, or were not fully enrolled in HIP, you have 60 days to choose a new plan. Just call the enrollment broker and tell them that you want to change health plans because you were unable to take part in the selection period. This does not change your eligibility period for the program during your redetermination. You still need to go through your redetermination process every 12 months. This will occur based on what month you started with HIP. 53

Part 5 – Member rights and responsibilities Member rights You and your provider can receive a copy of your Member Rights and Responsibilities by mail, fax, email, or on our website at anthem.com/inmedicaid. As a member of this health plan, you have the right to:
• Receive information about Anthem, the services we provide, Healthy Indiana Plan managed care program, doctors and facilities in your plan, and your rights and responsibilities. You will also be notified by phone call or mail if benefits, services, or service delivery sites change or end. You can find information about Anthem on our website at anthem.com/inmedicaid. You can also call Member Services at 866-408-6131 (TTY 711). • Get information about Anthem’s structure and operation. • Be treated with respect and with due consideration for your dignity and privacy. • Receive information on available treatment options and alternatives, presented in a way that is right for your condition and that you can understand. • Know that the date you joined Anthem is the date your benefits begin, and Anthem will not cover services you received before that date. • Choose a primary medical provider (PMP) who is part of the network, and change your PMP without cause or reason. • Know if your doctor takes part in a physician incentive plan through Anthem. Call us to learn more about this. • Receive covered services and medically necessary care in a timely and culturally competent manner. • Know which hospitals you should use and have access to them. • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in federal laws on the use of restraints and seclusion. • Request and receive a copy of your medical records. And you may request that they be amended or corrected, as stated in state and federal healthcare privacy laws. • Have honest talks with your doctors about the right treatment for your condition, in spite of the cost. • Find out how Anthem decides if new technology or treatments should be part of a benefit. • Have Anthem, doctors, and all of your care providers keep your medical records and health insurance information private. • Have your problems taken care of quickly. This includes things you think are wrong, as well as issues that have to do with your benefits, payment of services, or receiving an OK from us. • Have access to medical advice from your doctor, either in person or by phone, 24 hours a day, seven days a week. This includes emergency or urgent care. • Obtain interpreter services at no charge if you speak a language other than English, or if you have hearing, vision, or speech loss. • Voice complaints or appeals about Anthem, the plan, or the care that we provide to you. 54

• Ask for information and other Anthem materials (letters, newsletters) in other formats. These include Braille, large-sized print, or audio CD, at no charge to you. Call Member Services at 866-408-6131 (TTY 711). • Tell us what you would like to change about Anthem, including the member rights and responsibilities policy. • Question a decision we make about the care you got from your doctor. You will not be treated differently if you file a complaint. • Know that Anthem can make changes to Anthem benefits, as long as we tell you about them in writing before the changes take effect. • Know that Anthem does not take the place of workers’ compensation insurance. • Ask about our quality program and tell us if you would like to see changes made. • Ask us how we do utilization reviews and give us ideas on how to change them. • Know you will not be held liable if Anthem becomes insolvent (bankrupt and cannot pay its bills). • Make an advance directive. • Know that Anthem, your doctors, or your other healthcare providers cannot treat you differently for these reasons: o Your age o Your sex or gender identity o Your sexual orientation o Your race o Your national origin o Your language needs o The degree of your illness, health condition, or disability Member responsibilities As a member of this health plan, you have the responsibility to: • Tell us, your doctor, and your other healthcare providers when you need help and how you prefer to be supported. • Provide information to help us and your healthcare providers know how to support your healthcare needs. • Take the lead in developing your treatment goals using support as needed. • Follow through with your treatment plans (and instructions for care) you, your doctors, and your other healthcare providers agree to or let us know when the plan needs to be adjusted to help you to be successful at reaching your goals. • Treat your doctor and other healthcare providers with respect. • Make appointments with your doctor when needed, or reach out to us for support as needed. • Keep all scheduled appointments and be on time. • Call your doctor if you cannot make it to your appointment. • Always call your PMP first for all of your medical care (unless you have an emergency). • Show your ID card each time you receive medical care. • Use the emergency room only for true emergencies. • Tell Anthem and the Division of Family Resources (800-403-0864) if: 55

o You move. o You change your phone number. o You have any changes to your insurance. o Your income changes. o The number of people in your household changes. Privacy policies Anthem has the right to get information from those who give you care. We use this information so we can pay for and manage your healthcare. We keep this information private between you, your healthcare provider, and Anthem, except as the law allows. Refer to the Notice of Privacy Practices to read about your right to privacy. This notice is included at the end of this member handbook. Nondiscrimination Anthem does not engage in, aid, or perpetuate discrimination against any person by providing significant assistance to any entity or person that discriminates on the basis of race, color, or national origin in providing aid, benefits, or services to beneficiaries. Anthem does not utilize or administer criteria having the effect of discriminatory practices on the basis of gender or gender identity. Anthem does not select site or facility locations that have the effect of excluding individuals from, denying the benefits of, or subjecting them to discrimination on the basis of gender or gender identity. In addition, in compliance with the Age Act, Anthem may not discriminate against any person on the basis of age, or aid or perpetuate age discrimination, by providing significant assistance to any agency, organization, or person that discriminates on the basis of age. Anthem provides health coverage to our members on a nondiscriminatory basis, according to state and federal law, regardless of gender, gender identity, race, color, age, religion, national origin, physical or mental disability, or type of illness or condition. Members who contact us with an allegation of discrimination are informed immediately of their right to file a grievance. This also occurs when an Anthem representative working with a member identifies a potential act of discrimination. The member is advised to submit a verbal or written account of the incident, and is assisted in doing so if the member requests assistance. We document, track, and trend all alleged acts of discrimination. Members are also advised to file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR): • Through the OCR complaint portal at ocrportal.hhs.gov/ocr/portal/lobby.jsf • By mail to: U.S. Department of Health and Human Services, 200 Independence Ave. SW, Room 509F, HHH Building, Washington, DC 20201 • By phone at: 800-368-1019 (TTY/TTD: 800-537-7697) Anthem provides free tools and services to people with disabilities to communicate effectively with us. Anthem also provides free language services to people whose primary language is not English. 56

If you believe that Anthem has failed to provide these services, or discriminated in any way on the basis of race, color, national origin, age, disability, gender, or gender identity, you can file a grievance. Equal program access on the basis of gender Anthem provides individuals with equal access to health programs and activities without discriminating on the basis of gender. Anthem must also treat individuals consistently with their gender identity and is prohibited from discriminating against any individual or entity on the basis of a relationship with, or association with, a member of a protected class (such as race, color, national origin, gender, gender identity, age, or disability). Anthem may not deny or limit health services that are ordinarily or exclusively available to individuals of one gender, to a transgender individual based on the fact that a different gender was assigned at birth, or because the gender identity or gender recorded is different from the one in which health services are ordinarily or exclusively available. Making benefit decisions At Anthem, we care about you and want to help you get the healthcare you need. We do not give incentives for service denials, and we only make decisions based on appropriateness of care and available benefits. Your doctors and other health providers work with you to decide what’s best for you and your health. Your doctor may ask us for our OK to pay for certain healthcare services. We base our decision on two things: • Whether or not the care is medically necessary.* • What healthcare benefits you have. We do not pay or reward doctors or other healthcare workers to: • Deny you care. • Say you do not have benefits. • Approve less care than you need.

Medically necessary means Anthem will pay for services needed to: • Protect your life. • Keep you from getting seriously ill or disabled. • Reduce severe pain through the diagnosis or treatment of disease, illness, or injury. New medical treatments We want you to benefit from new treatments, so we review them on a routine basis. A group of PMPs, specialists, and medical directors decide if a treatment: • Is approved by the government. • Has shown in a reliable study how it affects patients. • Will help patients as much as, or more than, treatments we use now. • Will improve the patient’s health. 57

The review group looks at all of the details. The group decides if the treatment is medically necessary. If your doctor asks us about a treatment the review group has not looked at yet, the reviewers will learn about the treatment. They’ll let your doctor know if the treatment is medically necessary and if we approve it. Advance directives Advance directives are instructions you give about your future medical care in case there is a time you can’t speak or make decisions for yourself. By having an advance directive in place, this will not take away your right to decide your current healthcare choices. The advance directive also allows you to name a person to make decisions about your healthcare. They help your family and physician understand your wishes. With advance directives, you can: • Let your doctor know if you would or would not like to use life-support machines. • Let your doctor know if you would like to be an organ donor. • Give someone else permission to say “yes” or “no” to your medical treatments. Advance directives are only used if you can’t speak for yourself. It does not take away your right to make a different choice if you later become able to speak for yourself. You can make an advance directive by: • Talking to your doctor and family. • Choosing someone to speak or decide for you, known as a healthcare representative. • Creating a Power of Attorney. Types of advance directives recognized in Indiana: • Organ and tissue donation • Healthcare Representative • Psychiatric advance directives • Out of Hospital Do Not Resuscitate Declaration and Order and Physician Orders for Scope of Treatment (POST) • Power of Attorney For more information on advance directives and to find forms available to you, please visit the Indiana Health Care Quality Resource Center at in.gov/isdh/25880.htm.
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Part 6 – How to resolve a problem with Anthem How to get help
It is important that you are receiving the best care from Anthem and your providers. If you have a concern or question, you can call Member Services at 866-408-6131 (TTY 711). Member Services can help you with things like: • Finding a doctor. • Finding care and treatment. • Understanding how Anthem works. • Answering questions about any part of your healthcare. You will not be treated any differently if you call with a complaint or grievance. If you have a question If you’re not happy with the care you get from one of the doctors in your plan, please let us know. You, or someone you choose to act for you, can let us know your problem: • Use the Chat feature on the Sydney Health mobile app. • Log in to your online account through our secure portal at anthem.com/inmedicaid. • Call us at 866-408-6131 (TTY 711). • Send us a letter at: Anthem Blue Cross and Blue Shield P.O. Box 62429 Virginia Beach, VA 23466 Our Member Services staff will try to take care of your problem right away. They may have to send the information to the right staff member for a final answer. You may choose not to be named when you tell us, or send us information about, your problem. Grievances and appeals Grievances If you have a complaint or problem with the care you are getting, you can file a grievance with Anthem. A grievance can be a written letter or a phone call. A grievance can be filed at any time after a problem happens. You can first talk to your doctor or provider if you have any questions or concerns about your care. They can work with you on fixing the problem. If the problem isn’t fixed, you can call Anthem. If you have questions or concerns about not getting the care you need, you will file an appeal with Anthem. You can file an appeal in writing or by calling Member Services at 866-408-6131 (TTY 711). Grievance process • Anthem will send an acknowledgment letter within three business days after a grievance is reported. 59

• The grievance will be reviewed quickly, no later than 30 days following receipt of the grievance. • If your grievance is a result of a health crisis, please request an expedited (faster) review. Anthem with have 48 hours to resolve the grievance. • Once a decision has been made, Anthem will mail you a letter in your preferred language. You have four ways to file a grievance with us:

Call Member Services at 866-408-6131 (TTY 711).
Complete a grievance form found on anthem.com/inmedicaid.
Write us a letter to tell us about the problem. These are the things you need to tell us as clearly as you can: who is involved in the grievance, what happened, when did it happen, where did it happen, and why you’re not happy. Mail your completed form or letter, along with any documents, to: Grievance Coordinator Anthem Blue Cross and Blue Shield P.O. Box 62429 Virginia Beach, VA 23466
Fax your completed form or letter, along with any documents to: 855-516-1083. Just-cause grievances There might be a time when you want to change health plans but are not in your plan selection time. You may be able to due to certain reasons called “just cause.” If you have one of these reasons, you need to file a just-cause grievance with Anthem to see if you can change plans. The following are the “just-cause” reasons for switching health plans during the year for the HIP program: • Receiving poor quality of care • The plan does not, because of moral or religious objections, cover the needed services • Failure of the health plan to provide covered services • Failure of the health plan to comply with established standards of medical care administration • Significant language or cultural barriers • Corrective action levied against the health plan from FSSA • Limited access to a primary care clinic or other health services within reasonable proximity to a member’s residence • A determination that another managed care entity’s (MCE’s) formulary is more consistent with a new member’s existing healthcare needs • The member’s primary healthcare provider disenrolls from the member’s current MCE and reenrolls with another HIP MCE • Other circumstances determined by the FSSA or its designee to constitute poor quality of healthcare coverage If you have a “just-cause” grievance, call Anthem at 866-408-6131 (TTY 711). We will review your request and answer your questions. Call 877-GET-HIP-9 (877-438-4479) if you want help filing a just-cause grievance or changing health plans. 60

Appeals If you disagree with any action that denies or delays your care, you can file an appeal. An appeal is asking for a review because you do not agree with a decision the State, or Anthem, has made. You have the right to file an appeal if you disagree with the decision. You do not have to pay to file an appeal. You can also appeal if Medicaid or your plan stops providing or paying for all or part of a healthcare service, supply, or prescription drug you think you still need. • If you are on Medicaid and want to appeal a decision made about your healthcare, you can appeal in writing or over the phone to Anthem. • If you are on the HIP program, you should contact Anthem and work through their appeal process. • You must file an appeal within 60 calendar days from the date of the Notice of Adverse Benefit Determination letter. • If you would like to receive continued benefits during the appeal process, you must file the request for continuation of benefits within 10 calendar days of the mailing of the notice or the intended effective date of the proposed adverse benefit determination, whichever is later. If the appeal is not decided in your favor, you may have to pay for the services you received during the appeal process. You have three ways to file an appeal with us:

Call Member Services at 866-408-6131 (TTY 711).
Complete an appeal form found on anthem.com/in/medicaid/complaints grievances
Fax your appeal to: 855-516-1083.
Send your appeal to: Appeals Department Anthem Blue Cross and Blue Shield P.O. Box 62429 Virginia Beach, VA 23466 State fair hearing Once a decision is made on your appeal, a Notice of Appeal Resolution letter will be sent to you. This letter will tell you the reason for the decision. If you feel the decision is not correct, you may request a state fair hearing. You can write a letter telling the state why you think a decision is wrong. Please make sure to also include your name and other important information, like the dates of the decision, which is on the letter. You have three ways to file an appeal with FSSA:
Fax your appeal to: 317-232-4412
Email your appeal to fssa.appeals@oalp.in.gov
Mail your appeal to: Family and Social Services Administration Office of Administrative Law Proceedings-FSSA Hearings 100 N. Senate Ave., Room N802 Indianapolis, IN 46204 61

Appeals regarding eligibility decisions can be sent to the local Division of Family Resources (DFR) office. To find a DFR office near you, go to in.gov/fssa/dfr/2999.htm. For filing an eligibility related appeal with DFR, the appeal must be received by close of business not later than 33 days from the date of the action or issue being appealed. Close of business is 4:30pm, local time. The 33-day period is measured from the effective date of the action as recorded on the notice. If you file an appeal, you must do it within 120 calendar days after your problem happened or is set to happen. If your appeal is about a service you are still using, like in-home healthcare, you will get at least 10 days’ notice before your service is stopped. At your appeal hearing, you can speak for yourself or have help, or representation, from legal counsel, a friend, relative, or someone you trust to speak on your part. You will be shown your entire medical case file. You will be shown all materials used by FSSA, your county office, or the provider or health plan that relates to your appeal and used to make the original decision. External Review by Independent Review Organization If you do not agree with the appeal decision, you may also request an External Review by an Independent Review Organization (IRO). You or your authorized representative must request the IRO review in writing within 120 calendar days of receiving your appeal decision letter. The IRO will be conducted at no cost to you. The IRO will decide within 15 business days. The decision by the IRO is binding, meaning Anthem must obey their decision. To request an External Review by the Independent Review Organization, reach out to Anthem Member Services. Information to include when requesting an External Review: • Name • Member ID number • Phone number where you can be reached • Reason for your appeal • Any information you feel is important to your appeal request (examples include documents, medical records, or provider letters) Choosing a new health plan You can change to a different health plan for any reason during the first 60 days of membership. You can also change your health plan: • Once per calendar year for any reason at any time. • Using the just-cause process. • During the health plan selection period (mid-October to mid-December). • If you are an American Indian/Alaska Native (AI/AN) choosing not to use managed care and to change to state fee-for-service benefits. You can change health plans for “just cause” at any time if: • You have exhausted Anthem’s internal grievance process due to receiving poor quality of care, or if there are other instances that are determined to be poor quality of care. 62

• We can’t provide covered services. • We fail to comply with certain medical standards and practices. • There is a lack of access to providers experienced in dealing with your healthcare needs. • There are language or cultural barriers. • You have limited access to primary care clinics or other health services near you. • Another managed care entity (MCE) has a list of drugs that’s better for your healthcare needs. • You don’t have access to medically necessary services offered by Anthem. • A service is not covered by us for moral or religious reasons. • You need a group of related services at the same time, and not all related services are available in our health plan, and your provider says getting the services separately will be a risk to you. • Your primary medical provider (PMP) leaves Anthem and is enrolled with another MCE. • Other circumstances determined by the Office of Medicaid Policy and Planning (OMPP) or its designee to constitute poor quality of healthcare benefits. If we can no longer serve you We can’t keep you as a member of the health plan if you: • Lose your eligibility. • Are disenrolled from (no longer a member of) the HIP program. • Move out of Indiana. • Were signed up in error. • Become eligible for Medicare. You can disenroll from HIP at any time. If you want to continue with your health benefits, but disenroll from Anthem, there are certain rules. How to change health plans At certain times each year, you can choose to change your health plan. You can stay with your current health plan, or you can switch to a different one. You can only switch health plans during your plan selection time period. Right Choices Program members are not eligible to change plans. HIP members have plan selection for the first 60 days that they are eligible for coverage. Look out for a notice for your HIP plan selection time. If you have a question about changing your health plan or want to get the MCE change form, call the Healthy Indiana Plan Helpline at 877-GET-HIP-9 (877-438-4479). Quality improvement You deserve high quality medical and behavioral healthcare. Anthem’s Quality Improvement (QI) program reviews the services that you receive from Anthem doctors, hospitals, and other healthcare services. This ensures that you receive care that is good quality, helpful, and right for you. 63

Your health is important to us, and we believe quality work yields quality results. We make information about our Quality Improvement program available every year on our website and in writing to members upon request. We work hard to make sure you have access to great care. We do this by: • Having programs and services to help improve your quality of healthcare. • Providing learning tools on pregnancy and newborn care for all pregnant members and new moms. • Finding local programs in your community that help you receive these services if you need them. • Hosting learning events to answer your questions and concerns and help you make the most of your healthcare. • Following state and federal guidelines. • Looking at our quality results to find new ways to provide better care. Want to know more about how our Quality Management program works? Call us at 866-408-6131 and ask us to mail you a copy of our program flier. We can also tell you more about the ways Anthem makes sure you have quality healthcare services. You can review the quality and cost of care, as well. This can help you make the best decisions about your care. Visit these sites online to help you find out more: • The Leapfrog Group — leapfroggroup.org • Hospital Compare — medicare.gov/care-compare/ • Hospital Inpatient Quality Reporting Program — cms.gov/medicare/quality/initiatives/hospital-quality-initiative/inpatient reporting-program • Physician Quality Information — Indiana Health Information Exchange, found at ihie.org Your opinion is important to us. You will receive a member satisfaction survey each year to tell us how we’re doing. Your answers are anonymous. This information is used to improve our services and your care. If we helped you, please tell us in the survey.
You can also be part of our Community Advisory (CHANGE) meetings. As part of this group, you can tell us your views and ideas to help us understand what our members need. It will also help us find out how we can improve the quality and cost of healthcare. Fraud, waste, and abuse Fraud, waste, and abuse mean breaking the rules for personal gain. Fraud can be committed by providers, pharmacies, or members. Examples of provider fraud, waste, and abuse include doctors or other healthcare providers who: • Prescribe medicine, equipment, or services that are not medically necessary. • Don’t provide patients with medically necessary services due to lower reimbursement rates. • Bill for tests or services that were not provided. • Use wrong medical coding on purpose to get more money. 64

• Schedule more frequent return visits than are medically necessary. • Bill for more expensive services than provided. • Prevent members from getting covered services, resulting in underutilization of services. Examples of pharmacy fraud, waste, and abuse include: • Not dispensing drugs as written. • Submitting claims for a more expensive brand-name drug that costs more but giving a generic drug that costs less. • Dispensing less than the prescribed quantity and not letting the member know how to get the rest of the drug. Examples of member fraud, waste, and abuse include: • Inappropriately using services, such as selling prescribed narcotics or trying to get controlled substances from more than one provider or pharmacy. • Changing or forging prescriptions. • Using medications that you do not need. • Sharing your ID card with another person. • Not disclosing that you have other health insurance coverage. • Getting unnecessary equipment and supplies. • Receiving services or medicines under another person’s ID (identity theft). • Giving wrong symptoms and other information to providers to get treatment, drugs, etc. • Visiting the ER repeatedly for problems that are not emergencies. Medicaid members who are proven to have abused or misused their covered benefits may: • Be required to pay back any money we paid for services which were determined to be a misuse of benefits. • Be prosecuted for a crime and go to jail. • Lose their Medicaid benefits. Reporting fraud, waste, or abuse If you think your doctor, pharmacy, or a member is committing fraud, waste, or abuse, you must tell Anthem. You can call Anthem’s fraud reporting line, send an email, or fill out and mail a form. You do not have to tell them your name if you call or write. If you do not give your personal information, Anthem will not be able to call for other information. Do not send any sensitive personal information through email. Your report will be kept confidential to the extent permitted by law. Fraud reporting lines Call 800-403-0864 toll free, Monday through Friday, 8 a.m. to 4:30 p.m. Select option 5. When prompted, enter your ZIP code. Fax: 317-234-2244 Email: ReportFraud@fssa.IN.gov
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Fraud Reporting mailing address: FSSA Compliance Division, Room E-414 402 W. Washington St. Indianapolis, IN 46204 66

Index Words and acronyms used in this manual Advance directive A written explanation of a person’s wishes about medical treatments. This makes sure wishes are done if a person cannot tell a provider. Annual physical Visits to a primary medical provider (PMP) each year to check your health. This is often referred to as a wellness visit, preventive health exam, or checkup. Appeal A written or verbal request for a decision to be reversed. Benefit Healthcare service coverage that a Medicaid member receives for the treatment of illness, injury, or other conditions allowed by the State. Care management Program for members with special health conditions that helps members manage their conditions with routine contact and help from their health plan. Copayment A form of cost sharing. Copayments, or “copays,” refer to a specific dollar amount that an individual will pay for a particular service, regardless of the price charged for the service. The payment may be collected at the time of service or billed later. Covered service Mandatory medical services required by CMS and optional medical services approved by the State that are paid for by Medicaid. Examples of covered services are prescription drug coverage and physician office visits. Division of Family Resources (DFR) A division of the Family and Social Services Administration. The State agency that offers help with job training, public assistance, supplemental nutrition assistance, and other services. Eligible member Person certified by the State as eligible for medical assistance. Explanation of Benefits (EOB) An explanation of services rendered by your provider and any payments made toward those expenses. Family and Social Services Administration (FSSA) An umbrella agency responsible for administering most Indiana public assistance programs; includes the Office of Medicaid Policy Planning, the Division of Aging, the Division of Family Resources, the Division of Mental Health and Addiction, and the Division of Disability & Rehabilitative Services. Grievance A complaint about the health plan or providers. Health Needs Screening (HNS) A questionnaire members must complete so their health plan is aware of any healthcare conditions. This allows the health plan to match the members with the right programs and services. 67

Indiana Health Coverage Programs (IHCP) The name used to describe all of Indiana’s public health assistance programs, such as Medicaid, HCC, and CHIP. In network When a doctor, hospital, or other provider accepts your health insurance plan, that means they are in network. We also call them participating providers. Managed Care Entity (MCE) Organizations or health plans that oversee the overall care of a patient to ensure cost-efficient, quality healthcare to its members. Medicaid identification number The unique number assigned to a member who is eligible for Medicaid services. This number can be found on the front of your member ID card. Medically necessary Healthcare services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms, and that meet accepted standards of medicine. Nonparticipating provider A licensed healthcare professional who has not signed a contract to give services. This could be a doctor, hospital, or other provider. Primary medical A physician or advanced practice nurse, the majority of provider (PMP) whose practice is devoted to internal medicine, family/general practice, and pediatrics. An obstetrician/gynecologist may be considered a primary medical provider (PMP). Prior authorization (PA) An authorization required for the delivery of certain services. The Medical Services Contractor and State medical consultants review PAs for medical necessity, reasonableness, and other criteria. The PA must be obtained prior to the service for benefits to be provided within a certain time period, except in certain allowed instances. 68

Notice of Privacy Practices HIPAA Notice of Privacy Practices The original effective date of this notice was April 14, 2003. This notice was most recently revised in September 2024. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Information about your health and health beneﬁts is private. The law says we must keep this kind of information, called PHI, safe for our members. That means if you’re a member right now or if you used to be, your information is safe. We get information about you from state agencies for Medicaid and the Children’s Health Insurance Program after you become eligible and sign up for our health plan. We also get it from your doctors, clinics, labs, and hospitals so we can OK and pay for your healthcare. Federal law says we must tell you what we must do to protect PHI that’s told to us on the phone, written on paper, or saved on a computer. We also have to tell you how we keep it safe. To protect PHI that is: • On paper, we: – Lock our ofﬁces and ﬁles – Destroy paper with health information so others can’t get it • Saved on a computer, we: – Use passwords so only the right people can get in – Use special programs to watch our systems • Used or shared by people who work for us, doctors, or the state, we: – Make rules for keeping information safe (called policies and procedures) – Teach people who work for us to follow the rules When is it OK for us to use and share your PHI? We can share your PHI with your family or a person you choose who helps with or pays for your healthcare if you tell us it’s OK. Sometimes, we can use and share it without your OK: • For your medical care (treatment) – To help doctors, hospitals, and others get you the care you need • For payment reasons – To share information with the doctors, clinics, and others who bill us for your care – When we say we’ll pay for healthcare or services before you get them – To support you and help you get available beneﬁts • For healthcare business reasons (operations) – To help with audits, fraud, and abuse prevention programs, planning and everyday work – To ﬁnd ways to make our programs better 69

– With computer systems to help you We may get your PHI from different sources, and we may give your PHI to health information exchanges for payment, healthcare operations, and treatment. If you don’t want this, please visit anthem.com/inmedicaid for more information. • For public health reasons – To help public health ofﬁcials keep people from getting sick or hurt • With others who help with or pay for your care – With your family or a person you choose who helps with or pays for your healthcare, if you tell us it’s OK – With someone who helps with or pays for your healthcare, if you can’t speak for yourself, and it’s best for you We must get your OK in writing before we use or share your PHI for all but your care, payment, everyday business, research, or other things listed below. We have to get your written OK before we share psychotherapy notes from your doctor about you. We also would need your written OK if we were going to sell your PHI or to use or share it for marketing. You may tell us in writing that you want to take back your written OK. We can’t take back what we used or shared when we had your OK. But, we will stop using or sharing your PHI in the future. Other ways we can — or the law says we have to — use your PHI: • To help the police and other people who make sure others follow laws • To report abuse and neglect • To answer legal documents, like court orders • To give information to health oversight agencies for things like audits or exams • To help coroners, medical examiners, or funeral directors find out your name and cause of death • To help when you’ve asked to give your body parts to science • For research • To keep you or others from getting sick or badly hurt • To help people who work for the government with certain jobs, such as helping veterans with beneﬁts • To give information to workers’ compensation if you get sick or hurt at work • To give the Secretary of Health and Human Services information to put HIPAA rules into practice What are your rights? • You can ask to look at your PHI and get a copy of it. We will have 30 days to send it to you. If we need more time, we have to let you know. We don’t have your whole medical record, though. If you want a copy of your whole medical record, ask your doctor or health clinic. • You can ask us to change the medical record we have for you if you think something is wrong or missing. We will have 60 days to send it to you. If we need more time, we have to let you know. 70

• Sometimes, you can ask us not to share your PHI. But we don’t have to agree to your request. • You can ask us to send PHI to a different address than the one we have for you or in some other way. We can do this if sending it to the address we have for you may put you in danger. • You can ask us to tell you all the times over the past six years we’ve shared your PHI with someone else. This won’t list the times we’ve shared it because of healthcare, payment, everyday healthcare business or some other reasons we didn’t list here. We will have 60 days to send it to you. If we need more time, we have to let you know. • You can ask for a paper copy of this notice at any time, even if you asked for this one by email. • If you pay the whole bill for a service, you can ask your doctor not to share the information about that service with us. What do we have to do? • The law says we must keep your PHI private except as we’ve said in this notice. • We must tell you what the law says we have to do about privacy. • We must do what we say we’ll do in this notice. • We must send your PHI to some other address or in a way other than regular mail if you ask for reasons that make sense, like if you’re in danger. • We must tell you if we have to share your PHI after you’ve asked us not to. • If state laws say we have to do more than what we’ve said here, we’ll follow those laws. • We have to let you know if we think your PHI has been breached. Contacting you We, along with our afﬁliates and/or vendors, may call or text you using an automatic telephone dialing system and/or an artiﬁcial voice. We only do this in line with the Telephone Consumer Protection Act (TCPA). The calls may be to let you know about treatment options or other health-related beneﬁts and services. If you do not want to be reached by phone, just let the caller know, and we won’t contact you in this way anymore. Or you may call 844-203-3796 (TTY 711) to add your phone number to our Do Not Call list. What if you have questions? If you have questions about our privacy rules or want to use your rights, please call Member Services at 866-408-6131 for Hoosier Healthwise or the Healthy Indiana Plan, 844-284-1797 for Hoosier Care Connect, or 833-412-4405 for Indiana PathWays for Aging, Monday through Friday from 8 a.m. to 8 p.m. Eastern time. If you’re deaf or hard of hearing, call TTY 711. To see more information To read more information about how we collect and use your information, your privacy rights, and details about other state and federal privacy laws, please visit our Privacy web page at anthem.com/privacy or call Member Services at 866-408-6131 (TTY 711) for Hoosier Healthwise or the Healthy Indiana Plan, 844-284-1797 (TTY 711) for Hoosier Care Connect, or 833-412-4405 (TTY 711) for Indiana PathWays for Aging.
71

What if you have a complaint? We’re here to help. If you feel your PHI hasn’t been kept safe, you may call Member Services or contact the Department of Health and Human Services. Nothing bad will happen to you if you complain. Write to or call the Department of Health and Human Services: Ofﬁce for Civil Rights U.S. Department of Health and Human Services 233 N. Michigan Ave., Suite 240 Chicago, IL 60601 Phone: 800-368-1019 TDD: 800-537-7697 We reserve the right to change this Health Insurance Portability and Accountability Act (HIPAA) notice and the ways we keep your PHI safe. If that happens, we’ll tell you about the changes in a newsletter. We’ll also post them on the web at anthem.com/inmedicaid. Race, ethnicity, language, sexual orientation, gender identity, and other social factors that relate to your health We may collect, infer, receive, and/or maintain race, ethnicity, language, sexual orientation, gender identity, and other social factors that relate to your health (such as housing, transportation, or healthy food) information about you. We protect this information as described in this notice. We use this information to: • Make sure you get the care you need • Create programs to improve health outcomes • Create and send health education information • Let doctors know about your language needs • Provide interpretation and translation services We do not use this information to: • Issue health insurance • Decide how much to charge for services • Determine beneﬁts • Share with unapproved users 72

Your personal information We may ask for, use, and share personal information (PI) as we talked about in this notice. Your PI is not public and tells us who you are. It’s often taken for insurance reasons. PI can include different things like website usernames and passwords that you use, bank account numbers, and your job history. Your PI may be the same as PHI if it relates to your healthcare or your health plan. We protect your PI and your PHI as we talked about in this notice. • We may use your PI to make decisions about your: – Health – Habits – Hobbies • We may get PI about you from other people or groups like: – Doctors – Hospitals – Other insurance companies • We may share PI with people or groups outside of our company without your OK in some cases. • We’ll let you know before we do anything where we have to give you a chance to say no. • We’ll tell you how to let us know if you don’t want us to use or share your PI. • You have the right to see and change your PI. • We make sure your PI is kept safe. This information is available for free in other languages. Please contact our Member Services number at 866-408-6131 (TTY 711) for Hoosier Healthwise or the Healthy Indiana Plan, 844-284-1797 (TTY 711) for Hoosier Care Connect, or 833-412-4405 (TTY 711) for Indiana PathWays for Aging, Monday through Friday from 8 a.m. to 8 p.m. Eastern time. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Revised September 2024 Your medical records Federal and state laws allow you to see your medical records. Ask your PMP for your records ﬁrst. If you have a problem obtaining your medical records from your doctor, call Member Services at 866-408-6131 (TTY 711). Review of member records By using the beneﬁts described in this handbook, you agree to allow us, or someone we choose, to look at your medical records for these reasons: 73

• Utilization review • Quality assurance • Peer review 74

ھﻞ ﺗﺤﺘﺎج ﻟﻤﺴﺎﻋﺪة ﻓﯿﻤﺎ ﯾﺘﻌﻠﻖ ﺑﺮﻋﺎﯾﺘﻚ اﻟﺼﺤﯿﺔ أو ﺗﺤﺘﺎج ﻟﻠﺤﺪﯾﺚ ﻣﻌﻨﺎ أو ﻗﺮاءة ﻣﺎ ﻧﺮﺳﻠﮫ ﻟﻚ؟ ﻧ ّﻮﻓﺮ اﻟﻤﻮاد اﻹرﺷﺎدﯾﺔ ﺑﻠﻐﺎت وﺻﯿﻎ أﺧﺮى، دون أي ﺗﻜﻠﻔﺔ ﻋﻠ ﯿﻚ. اﺗﺼﻞ ﺑﻨﺎ ﻋﻠﻰ اﻟﺮﻗﻢ اﻟﻤﺠﺎﻧﻲ
(؛ Healthy Indiana Plan ؛Hoosier Healthwise) 866-408-6131 Indiana ) 833-412-4405 (؛Hoosier Care Connect) 844-284-1797 TTY 711 . (؛PathWays for Aging

˪ Do you need help with your healthcare, talking with us, or reading what we send you? We provide our materials in other languages and formats at no cost to you. Call us toll free at 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711. Spanish ¿Necesita ayuda con su cuidado médico, para hablar con nosotros o leer lo que le enviamos? Proporcionamos nuestros materiales en otros idiomas y formatos sin costo alguno para usted. Llámenos gratuitamente al 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711. Arabic Burmese သင ့်ကျန်းမာေရးေစာင ေ့်ǹှာက်မ˪ ǳှင ပတ်သက်၍ြဖစ်ေစ၊ ကȁǳပ ်တǳ င ေဆးွ ေǳးွ ရာတငွ ြ် ဖစေ် စ၊ ကȁ ǳပ ်တ ပ လ ိုက်သည့်စာက ဖတ်Ǹ ရာတွငြ ဖစ်ေစ အကူအညီလိုအပ်ပါသလား။ ကȁǳ ပ ်တ၏ အချက

်အလက်စာရက

်စာတမ်းမျ ာ းက အြခားဘာသာစကားများ၊ ပစ ံမျာ းြဖင သငအ ် ့ တ ွက ် အခမ ပပ ုိး ေပးပါသည။် 866- 408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711 တွင ကȁǳပ်တထ အခမ ဖုနးေခါ်ဆိုပါ။ ှ့ ့် ို ့ ်ု ် ့ ်ု ိုို့ ို ် ်ု ို ွ ့ ို ံ ု ့ ဲ့ ့် ံ ် ်ု ဲ့ ံ ် ့ို 您在健康護理方面、與我們交流或閱讀我們寄送的材料時是否需要幫助？我們以其他語言和格式提供我們的資料，您無需支付任何費用。請撥打免費電話聯絡我們： 866-408-6131 (Hoosier Healthwise, Healthy Indiana Chinese 75

Ʌ Plan)；844-284-1797 (Hoosier Care Connect)；833-412-4405 (Indiana PathWays for Aging)；TTY 711。 Dutch Hebt u hulp nodig bij uw gezondheidszorg, om met ons te praten of bij het leesmateriaal dat we u sturen? We verstrekken onze materialen in andere talen en indelingen zonder extra kosten voor u. Bel ons gratis op 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711. French Avez-vous besoin d’aide pour vos soins de santé, pour communiquer avec nous ou pour lire les documents que nous vous envoyons ? Nous mettons gratuitement à votre disposition nos documents dans d’autres langues et formats. Appelez-nous gratuitement au 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging) ; TTY 711. German Benötigen Sie Hilfe bezüglich Ihrer Gesundheitsversorgung, möchten Sie mit uns sprechen oder haben Sie Probleme, die von uns zugesandten Materialien zu lesen oder zu verstehen? Wir stellen unsere Materialien kostenfrei in anderen Sprachen und Formaten bereit. Rufen Sie uns gebührenfrei an unter 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan), 844-284-1797 (Hoosier Care Connect), 833-412-4405 (Indiana PathWays for Aging), TTY 711. Hindi क्या आपको अपनी स्वास्थ्य देखभाल, हमसे बातचीत करने या हमारȣ ओर से भेजी गई चीज़ɉ को पढ़ने मɅ मदद चाǑहए? हम अपनी सामĒी आपको दसरȣ भाषाओं और ू फ़ॉमȶट मɅ मुफ़्त उपलब्ध कराते हɇ। हमɅ टोल ŉȧ नंबर 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711 पर फ़ोन कर। ヘルスケアの受診、ご相談時の会話、配布物の読解にお困りではありませんか？当院では無料の翻訳版資料をご用意しております。フリーダイヤルへお電話ください： 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412- 4405 (Indiana PathWays for Aging); TTY 711. Japanese 76

의료 서비스, 당사와의 소통 또는 당사에서 보내는 자료 읽기와 관련해 도움이 필요하십니까 ? 자료를 다른 언어및 형식으로 무료로 제공해드립니다. 수신자 부담 전화 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan), 844-284-1797 (Hoosier Care Connect), 833-412- 4405 (Indiana PathWays for Aging), TTY 711 으로 연락하십시오 . Korean Pennsylvania Dutch Brauchscht du Hilf fer Care griege, fer schwetze mit uns, odder fer Schtofft lese as mer dich schicke? Mir gewwe dich uffgschriwwener Schtofft in differnti Schprooche un Formats unni as es dich ennich eppes koschte zellt. Ruf uns uff fer nix an die 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711. ਂ ਕੀ ਤੁਹਾਨੂੰ ਆਪਣੀ ਹੈਲਥ ਕੇਅਰ, ਸਾਡੇ ਨਾਲ ਗੱਲ ਕਰਨ, ਜਾਂ ਅਸੀ ਂਤੁਹਾਨੂੰ ਜੋ ਸਮੱਗਰੀ ਭੇਜਦੇ ਹਾ ਂ ਉਸ ਨ ੂੰ ਪੜ ୧ ਨ ਿਵੱਚ ਮਦਦ ਚਾਹੀਦੀ ਹੈ? ਅਸੀ ਂਤੁਹਾਨੂੰ ਆਪਣੀ ਸਮੱਗਰੀ ਹੋ ਰਨਾ ਂ ਭਾਸ਼ਾਵਾਂ ਅਤੇ ਫ਼ਾਰਮ ੈਟਾ ਂ ਿਵੱਚ ਬਗੈਰ ਿਕਸੇ ਖਰਚ ਦੇ ਮੁਹੱਈਆ ਕਰਾਉ ਦ ਹਾ। ਸਾਨੂੰ
866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan);
844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711 'ਤੇ ਟੋਲ ਫ਼୥ੀ ਕਾਲ ਕਰੋ। ੇ ੇ ਂ Punjabi Russian Вам нужна помощь в получении медицинских услуг, вы хотите поговорить с нами или не можете прочитать присланные вам материалы? Наши материалы можно бесплатно получить на других языках и в другом формате. Позвоните нам по бесплатному телефону 866-408-6131 (Hoosie Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect 833-412-4405 (Indiana PathWays for Aging); TTY 711. Tagalog Kailangan mo ba ng tulong sa iyong pangangalagang pangkalusugan, sa pakikipag-usap sa amin, o sa pagbabasa ng mga ipinadala namin sa iyo? Ibinibigay namin ang aming mga materyales sa iba pang wika at format nang wala kang babayaran. Tumawag sa amin nang libre sa 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711. Vietnamese Quý vị có cần trợ giúp vê d ̀ ịch vụ chăm sóc sức khỏe, trao đổi với chúng tôi hoặc đọc những tài liệu mà chúng tôi gửi cho quý vị không? Chúng tôi cung câp ́ miên ̃ phí cho quý vi ̣các tài liêu ̣ cua ̉ chúng tôi bằng các ngôn ng ư và đinh ̣ dạng khác. Hãy gọi cho chúng tôi theo số điện thoại miễn phí 866-408-6131 (Hoosier Healthwise, Healthy ̃ 77

Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); TTY 711. Anthem follows federal civil rights laws. We don’t discriminate against people because of their: • Race • Color • National origin • Age • Disability • Sex or gender identity That means we won’t exclude you or treat you differently because of these things. Communicating with you is important For people with disabilities or who speak a language other than English, we offer these services at no cost to you: • Qualiﬁed sign language interpreters. • Written materials in large print, audio, electronic, and other formats. • Help from qualiﬁed interpreters in the language you speak. • Written materials in the language you speak. To get these services, call the Member Services number on your ID card. Or you can call our Grievance Coordinator at 866-408-6131 (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (Hoosier Care Connect); 833-412-4405 (Indiana PathWays for Aging); 844-284-1797 (Hoosier Care Connect); TTY 711. Your rights Do you feel you didn’t get these services, or that we discriminated against you for reasons listed above? If so, you can ﬁle a grievance (complaint). File by mail or phone: Anthem Blue Cross and Blue Shield Member Appeals and Grievances P.O. Box 62429 Virginia Beach, VA 23466 Phone: 866-408-6131 (TTY 711) (Hoosier Healthwise; Healthy Indiana Plan)

844-284-1797 (TTY 711) (Hoosier Care Connect) 
844-284-1797 (TTY 711) (Hoosier Care Connect)

Need help ﬁling? Call our Grievance Coordinator at the number above. You can also ﬁle a civil rights complaint with the U.S. Department of Health and Human Services, Ofﬁce for Civil Rights: • On the web:
ocrportal.hhs.gov/ocr/portal/lobby.jsf 78

• By mail:
U.S. Department of Health and Human Services
200 Independence Ave. SW Room 509F, HHH Building Washington, DC 20201 • By phone:
800-368-1019 (TTY/TDD 800-537-7697) For a complaint form, visit hhs.gov/ocr/ofﬁce/ﬁle/index.html. 79

anthem.com/inmedicaid 1022394INMENABS 04/25

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