Open Enrollment

🗓️ Open Enrollment Period

With the Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect programs, you must remain enrolled in your chosen health plan for a one-year period so long as you remain eligible. This gives your health plan an opportunity to improve the care it provides. You may only change your health plan during open enrollment periods or if your change reason falls under one of the "just cause" reasons outlined below.

Open Enrollment Periods

• 1. Anytime during your first 90 days with a new health plan.

  2. Annually during your open enrollment period.

⚖️ "Just Cause"

Anytime you file a grievance with your health plan and the state finds that you have a good reason to change health plans you may change health plans based on "just cause." This is when you have concerns over the quality of care being provided by your health plan. You must first contact your health plan so they can attempt to resolve your concern. If you are still unhappy after contacting your health plan, you can call the helpline of the program in which the member is enrolled, and they will review your request.

"Just Cause" Reasons for Hoosier Healthwise and Hoosier Care Connect

The following are the "just cause" reasons for switching health plans during the year for the Hoosier Healthwise and Hoosier Care Connect programs:

• Receiving poor quality of care

• 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 by the Family and Social Services Administration (FSSA)

• Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence

• A determination that another health plan's formulary is more consistent with a new member's existing health care needs

• Lack of access to medically necessary services covered under the health plan's contract with the state

• A service is not covered by the health plan for moral or religious objections

• Related services are required to be performed at the same time and not all related services are available within the health plan's network, and the member's provider determines that receiving the services separately will subject the member to unnecessary risk

• Lack of access to providers experienced in dealing with the member's healthcare needs

• The member's primary healthcare provider disenrolls from the member's current health plan and re-enrolls with another health plan

• Other circumstances determined by FSSA or its designee to constitute poor quality of health care coverage

"Just Cause" Reasons for the Healthy Indiana Plan (HIP)

The following are the "just cause" reasons for switching health plans during the year for the Healthy Indiana Plan (HIP) program:

• 1. Receiving poor quality care

  2. Failure of the health plan to provide covered services

  3. Failure of the health plan to comply with established standards of medical care administration

  4. Lack of access to providers experienced in dealing with the member's health care needs

  5. Significant language or cultural barriers

  6. Corrective action levied against the health plan by the FSSA

  7. Limited access to a primary care clinic or other health services within reasonable proximity to a member's residence

  8. A determination that another health plan's formulary is more consistent with a new member's existing health care needs

  9. Other circumstances determined by the FSSA or its designee to constitute poor quality of health care coverage