Saint Anthony Medical Center is site for SCHIP Enrollment

Saint Anthony Medical Center is a site for anyone eligible to sign up for the State Children’s Health Insurance Program (SCHIP), also known as Hoosier Healthwise Package C, which will provide age appropriate preventative, primary and acute care services to approximately 40,000 uninsured children statewide.

According to the Indiana Health Coverage Programs, in order to be eligible for SCHIP, a child must meet the following criteria:

• must be younger than 19 years old
• the child’s family income must be between 150 and 200 percent of the Federal poverty level;
• the child must not have credible health insurance at any time during the three month period prior to applying for the Hoosier Healthwise program and
• the child’s family must satisfy all cost-sharing requirements.

The following services have coverage limitations:

Early intervention services – Package C covers immunizations, and initial and periodic screenings according to the HealthWatch EPSDT periodicity and screening schedule.  Coverage of treatment services is subject to the Package C benefit limitations.

Podiatry Services – Surgical procedures involving the foot, laboratory or x-ray services, and hospital stays are covered when medically necessary.

Chiropractic Services – Coverage is limited to five visits and 14 therapeutic physical medicine treatments per member each year.  Additional treatments may be covered if prior authorization is obtained based on medical necessity.

Medical Supplies and Equipment – Coverage is available for a maximum benefit of $2,000 per year and $5,000 per lifetime per member.

Therapies – Physical, speech, occupational and respiratory therapy is covered for a maximum of 50 visits each year, per type of therapy.

Prescription drugs – Pharmacists may substitute the generic equivalent of a brand name drug only when the prescribing physician has indicated on the written or orally communicated prescription that the generic equivalent may be substituted.

Inpatient rehabilitative services – Coverage is available for a maximum of 50 days per calendar year.

Mental health/substance abuse services – Coverage for outpatient office visits is limited to a maximum of 30 visits each year, per member, without prior authorization to a maximum of 50 visits per year.

The following services are NOT covered by Hoosier Healthwise Package C:

• Nursing facility services
• Private duty
• Community mental health rehabilitation
• Intermediate care facilities for the mentally retarded
• Case management for persons with HIV
• Case management for pregnant women
• Case management for mentally ill or emotionally disturbed
• Non-ambulance transportation
• Christian science nurses

For more information regarding SCHIP enrollment at Saint Anthony Medical Center, contact Dorothy Jackson at 219.757.6204 or Tammy Byers at 219.757.6069.