Benefits Overview

Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. MHS pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Member Services at 1-877-647-4848 (TTY: 1-800-743-3333).

As a MHS Member, you can choose who you see for your healthcare needs from our network of Providers. We have many for you to choose from. If you need help choosing a doctor, call Member Services at 1-877-647-4848 (TTY: 1-800-743-3333).

Get Your Preventive Care Regularly

We visit the doctor when we are sick or hurt so that we can get better, but doctors can help us when we’re not sick, too. Doctors can help us find the early warning signs of health problems so that we can change our lifestyles or take medications that will keep us from getting sick – or worse. We also get immunizations (shots) that keep us from getting diseases that can cause wide-spread sickness in our communities.

The best way to stay healthy is to get your regular preventive care. Preventive care visits are covered for all MHS members. This means visiting the doctor for a regular check-up, rather than waiting until you are sick. Every year, adults need to receive an annual check-up from their doctor. MHS covers an annual physical for adults. Depending on your age and gender, you may need certain screenings and even immunizations.

Review the Immunization Schedules and Preventive Care Guidelines

Women’s Health | Preventive Care

Women need certain health tests men don’t need. These tests are simple screenings that can make a big difference. All women should talk to their doctor about getting preventive care screenings such as Pap tests, chlamydia tests and mammograms. Women’s preventive health screenings and getting birth control (family planning) are self referral services. That means you can see a doctor other than your MHS doctor. You do not have to get a referral from your doctor, but you must visit an Indiana Medicaid network provider.

Men’s Health | Preventive Care

Men need preventive services too. Talk to your doctor about specific recommendations based on your age and medical history. 

Be Prepared for Your Doctor Visit

Follow these tips to get the most out of each doctor visit:

• Bring your insurance card and photo ID.
• Turn off your cell phones and other electronic devices.
• Write down a list of questions to ask the doctor.
• Bring your medical and shot records and any medicine you are currently taking.
• Arrive on time.
• Describe symptoms and complaints.
• Ask questions and take notes during each visit.
• Discuss your next steps for your care plan with the doctor.
• Schedule follow-up visits and any yearly checkups.

Get Your Child's Preventive Care Regularly

The best way to stay healthy is to get your regular preventive care. Preventive care visits are covered for all MHS members. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.

Regular child check-ups are also covered for those under the age of 21. These doctor visits should occur at the below ages. 

• Birth or neonatal exam
• 2 to 4 days for newborns discharged less than 48 hours after delivery
• By 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 24 months
• 30 months
• Once per year from 3 years through 20 years

Search for a provider in our network.

Children also need a blood lead test between 9 and 15 months. If the child is at high risk for lead exposure, the first lead screening should be at the 6 month visit. Children should have another blood level test between ages 21 and 27 months.  Any child between 28 and 72 months who has not had a blood lead test must have one as soon as possible. 

MHS adopts the American Academy of Pediatrics’ schedule for well-child checkups, which includes a list of suggested preventive health services based on age. Click here for a complete listing of the preventive health guides (PDF). More importantly, you should ask your doctor at each visit if your children are up to date and current on all preventive health requirements for children up to age 21.

You can earn My Health Pays rewards for each well-child checkup for children 0-15 months, for up to six visits. You can also earn My Health Pays rewards for each yearly well-child checkup for children age 15 months to 20 years old.

Exams and Screenings for Your Child

There are a series of tests your child needs to receive every year from birth to age 21. These tests are called well-child checkups, HealthWatch visits or EPSDT visits (Early Periodic Screening, Diagnosis and Treatment). Your child should be screened early so health problems can be found and treated. MHS and your doctor will remind you when it’s time for your next screening.

EPSDT screenings include:

• Health and development history
• Physical exam
• Nutrition evaluation
• Development evaluation
• Vision, hearing and dental exams
• Lab tests, including lead levels
• Health education

Immunizations (Shots)

Your doctor will usually give immunizations (shots) during a well-child check-up. Each one of these shots helps protect your child, your family, and your community from dangerous disease and illness. If you think your child may be due for an immunization, please call to set up their next appointment right away.

Review the Immunization Schedules and Preventive Care Guidelines

Be Prepared for Your Doctor Visit

Follow these tips to get the most out of each doctor visit:

• Bring your insurance card and photo ID.
• Turn off your cell phones and other electronic devices.
• Write down a list of questions to ask the doctor.
• Bring your medical and shot records and any medicine you are currently taking.
• Arrive on time.
• Describe symptoms and complaints.
• Ask questions and take notes during each visit.
• Discuss your next steps for your care plan with the doctor.
• Schedule follow-up visits and any yearly checkups.

MHS 24/7 Free Nurse Advice Line

Everyone has questions about their health. If you have a question, you can reach the MHS 24 hour nurse advice line at 1-877-647-4848. The MHS nurse advice line is a free, medical advice phone line staffed by bilingual licensed nurses. It is open 24 hours a day, every day of the year. You can learn more by using the Nurse Advice Line brochure (PDF).

Here are some questions you might ask:

• Questions about pregnancy
• What to do if your baby is sick
• How to deal with asthma
• How much medicine to use/give
• When to go to the emergency room

The Ombudsman Program is designed to assist MHS members in finding effective ways to resolve concerns or complaints about the benefits and services provided under their MHS coverage plan. The program will provide support to members and their families or representatives and work with MHS and providers to solve problems and misunderstandings and create responses based on an individual’s needs. The Ombudsman toll-free number is 1-877-647-5326.

The aim of the ombudsman program is to provide MHS members with free and easy access to an independent party which will investigate and help with member concerns, provide member education, and help members contact the right people for assistance within the Medicaid system and MHS. It is the hope of MHS that our members will feel comfortable accessing a trusted community-based organization with any concerns they may have about the health plan or the services they have received. A non-profit, independent organization manages the Ombudsman program.

You do not have to use the ombudsman. You can talk to MHS directly about any problems you may be having.

If you would like to learn more about the Ombudsman program, please call MHS Member Services.

MHS provides bilingual staff or an interpreter to help members who speak languages other than English. We can help schedule appointments and answer questions over the phone. This service is free to use. Call MHS Member Services at 1-877-647-4848 and ask for language assistance.

Hearing impaired members can call the Indiana Relay Service at 1-800-743-3333 for TTY service. This number can be used anywhere in Indiana. Ask the operator to connect you to MHS at 1-877-647-4848 or to any other number. Tell your doctor if you need a sign language interpreter for your medical visits.

Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.

If you need something translated into a language other than English, please call MHS. We can also provide things in other formats such as Braille, CD or large print.

What is a Referral?

Sometimes your PMP may want you to get care from other providers. When this happens, you must get approval from your PMP. This is called a referral. A referral will let you go to another MHS doctor, hospital, or lab.

Your PMP will:

• Give you a written note of approval to take with you when you get the service
• Arrange the service for you
• Tell you how to get the service

Seeing a Specialist

A specialist is a doctor who works in one healthcare area. For example, a doctor who only works with the heart (a cardiologist) is a specialist. Your PMP will provide you with a referral if you need to see a specialist. The specialist will be an MHS provider.

Prior Authorization

Some services need approval from MHS before you get them. This is called prior authorization (PA). Your doctor must tell MHS about your health to get authorization. MHS will then decide if the requested care and services are appropriate. MHS will not pay for the services if your doctor does not get prior authorization when needed. If you want to know more about prior authorization, call Member Services at 1-877-647-4848 (TTY/TDD: 1-800-743-3333) Monday through Friday from 8 a.m. to 8 p.m., Eastern Time.

Below is a list of services that require PA.