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HIP Enhanced Service Plan (ESP)
Overview
What is HIP ESP?
The HIP Enhanced Services Plan (ESP) is designated for certain
individuals with health care conditions that require additional support.
These conditions include:
 Internal Cancers
 HIV/AIDS
 Hemophilia
 Aplastic Anemia
 Organ Transplants
How is a person enrolled in HIP ESP?
 The application for HIP does NOT allow a member to
select HIP ESP as their plan.
 Plan selections include Anthem and MDwise.
 Medical questions and consent for medical records is
used to determine if a person qualifies for HIP ESP.
 If an applicant answers ‘yes’ to any medical questions,
they are reviewed for possible inclusion in the ESP plan.
 Medical record review determines if a member remains
in ESP or is sent to their original plan choice.
What is Covered?
The benefits under the HIP-ESP Plan are identical to benefits offered
by the other HIP insurers:
 Lifetime Maximum - $1M
 Benefit Year Maximum - $300,000
 Health benefits include hospital services, mental health
care, doctor visits, prescriptions, diagnostic exams and
disease management.
 HIP ESP does not cover pregnancy, vision or dental
 The POWER Account for HIP ESP participants is handled
differently than commercial carriers.
HIP ESP members may be treated by any
provider enrolled with EDS in the Indiana
Health Coverage Programs (IHCP).
How Much Does it Cost?
 Members must pay a small monthly Contribution
 The exact cost of the Contribution depends on income
and family size.
 Monthly Contributions may be reduced by other medical
payments made within a household, including
premiums made to the Hoosier Healthwise program.
 An individual’s employer may contribute up to 50%
of the individual’s required contribution for the program.
How Much Does it Cost?
Example Contribution Illustration
Single Adult, No Children
Monthly Income
Percent
Contribution
Estimated Monthly
Contribution
$0 - $850
2%
$17
$851 – $1063
3%
$32
$1064 - $1276
4%
$51
$1277 - $1489
5%
$74
Who is Managing HIP ESP?
The State has contracted with the Indiana Comprehensive
Health Insurance Association (ICHIA). ICHIA also operates the
State’s high-risk pool.
ICHIA contracts with ACS to handle member services and
claims, and APS for disease management services and
utilization management.
ACS and APS have experience providing health care to
persons with significant and serious health conditions.
EDS processes pharmacy claims
.