Member Services

Presumptive Eligibility (PE) Adult includes all covered services available under the _____________ benefit plan. (Select the most appropriate response)

• HIP Plus

• HIP Basic

• Package A Standard

• HIP Basic State

After the DFR decides on the full application, the Presumptive Eligibility for Pregnant Women (PEPW) plan will be assigned to either (select all that apply):

• HIP Maternity under HIP

• Package A Standard Plan under Hoosier Healthwise (HHW)

• Family Planning on Fee-for-Service (FFS)

• Disability Medicaid

There are three members who require a TPL update, how many CTNs are required for this call? (Select the most appropriate response)

• One CTN

• Three CTNs

Fluoride treatment (dental) is only covered for IHCP members 21 years or older. (Select true or false)

• False

• True

The IHCP covers general anesthesia for members 21 years old and older only if the procedure is performed in an inpatient or outpatient hospital setting, or in an ambulatory surgical center (ASC). (Select true or false)

• False

• True

Family planning includes the below services to an IHCP member with only family planning services as a benefit plan. (Select the most appropriate responses)

• Tubal ligation

• Vasectomy

• Annual family planning visits

• FDA approved oral contraceptives and contraceptive

• Artificial insemination

The maximum amount reimbursed for frames is ____ per pair, except when medical necessity requires a more expensive frame.

• $25

• $20

• $15

• $30

The IHCP covers contact lenses when they are medically necessary, such as severe allergy to the frame material. (Select true or false)

• True

• False

Individualized Education Program (IEP) services are carved out of IHCP managed care programs and are therefore exempt from primary medical provider (PMP) referral requirements for managed care members. (select true or false)

• True

• False

Medical Review Team (MRT) only coverage refers to a member with the following coverage: (select the most appropriate response)

• No coverage

• Limited coverage - assists the DFR to determine if an applicants significant impairment is expected to last a minimum of 12 months

• Pays for Medicare Part A premium

• Emergency services only