Indiana PathWays For Aging

• Doctor care
• Hospital services
• Emergency and urgent care
• Home- and community-based services
• Care and service coordination
• Lab tests and X-rays
• Medical supplies
• Chiropractic services
• Behavioral healthcare
• Prescription drugs
• Immunizations
• Smoking cessation support
• Podiatry services
• Transportation
• Housing support
• Caregiver support

See the PathWays member handbook for more details.

Dental care you receive

• Two exams and one cleaning every year
• Bitewing X-ray once every year and one complete set of X-rays every three years
• Other medically necessary services

 PathWays Dental Benefits Flier - English

 PathWays Dental Benefits Flier - Spanish

For help finding a dentist in your area

Call DentaQuest toll free at 888-291-3762 or visit DentaQuest.

Administered by DentaQuest, an independent company that does not provide Blue Cross and/or Blue Shield products.

Eye exams

• One eye exam every two years. 
• Additional examinations must be medically necessary. 

Eyeglasses (including frames and lenses)

• One pair of eyeglasses every 5 years.

For help finding an eye doctor in your area

Call Superior Vision toll free at 866-866-5641 (TTY 866-428-4833) or visit their website.

You may have conditions that require special care and providers. We have care coordination programs and services to help you. They help manage your physical, behavioral, medical and social needs.

Condition Care

We help guide the care for our members with chronic health conditions. We’ll help you to understand your condition and meet healthcare goals through education, resources, and referrals to providers for care.

Care Management

Our care management team helps members who need assistance with care coordination, making preventive care appointments, or accessing care to address chronic physical or behavioral health conditions.

Complex Case Management

Anthem's Complex Case Management program is for members with complex needs who need help managing their healthcare. We can work with you and your provider, or just with your provider, to make sure you are getting the right care, at the right time and in the right place.

Service Coordination

We will help coordinate services in your home that will help you maintain your independence. We also provide an extra layer of support for those who are in a nursing facility to ensure you have the care and support you need, including transitioning back home if you choose to.

If you have a higher need for care and meet the requirements for Nursing Facility Level of Care (NFLOC), you will qualify for home and community-based services, or you may choose to receive your care in a nursing facility. If you meet NFLOC requirements, you will receive Service Coordination in addition to Care Coordination.

Learn more

Home- and community-based services (HCBS) are available to eligible members who need long term-term care. These members choose to remain in their home instead of living in a long-term care institution, such as a nursing facility. HCBS help a person to be as independent as possible and live in the least restrictive environment possible while maintaining safety in the community. 

• Adut day service
• Adult family care
• Assisted living
• Attendant care
• Care management
• Structured family care
• Community transitions
• Personal emergency response
• Integrated health care coordination
• Home delivered meals
• Home modification assessment
• Home modification
• Home and community assistance
• Transportation
• Nutritional supplements
• Pest control
• Respite
• Specialized medical equipment and supplies
• Vehicle modification
• Participant directed attendant care services
• Caregiver coaching

Not all PathWays members are eligible for HCBS. See your member handbook for more details about each of these services.

Your benefits include a wide range of prescription and many over-the-counter (OTC) drugs. We work with CarelonRx to provide these pharmacy benefits.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is covered.

On top of your regular PathWays benefits, you can receive these extras just for being our member. You can access these benefits in a few different ways.

Some extra benefits can be ordered by logging in to the secure Benefit Reward Hub. These include:

• Up to $50 for over-the-counter personal care products.
• One item of COPD relief products.
• One healthy lifestyle aid, such as a digital scale, lumbar pillow, and diabetic supplies.
• Choose up to $75 in sensory products, including coloring books, puzzles, games, arts and crafts, or weighted blankets.
• $50 in basic home essentials, such as bedding, cutlery, dishes, and towels.
• One home safety product per year, such as carbon monoxide detectors, medication lock boxes, smoke alarms, fire extinguishers, or non-skid tub mat.
• A memory aid kit including a photo album, digital music player, $10 music gift card, and personalized name labels.
• Transportation essentials - choose a $50 gas card or ride-share card.

For these extras, call Member Services 833-412-4405 (TTY 711):

• Healthy Adults Healthy Results – online fitness programs and resources and a home fitness kit.
• Post-discharge meals ― medically-tailored meals delivered to your home after your hospital stay.
• Fresh Food Connect ― your choice of healthy food deliveries to your doorstep.
• Companion Connect ― connect with a loved one through a smart speaker including video capabilities.
• Caregiver Way Membership Program ― support and training opportunities for caregivers.
• Vision Rehabilitation Training ― community-based services and in-home programs for individuals with visual impairments.
• Smartphone Member Connect ― support and guidance in getting smartphone services to stay in touch with family, friends, doctors and social services.

More resources you can access directly:

• Digital Mental Health Toolkit ― access the Emotional Well-being Resources and Recovery Library to help you better control the thoughts and behaviors that affect your emotional well-being.  
• Community Resource Link — find food, jobs, housing, and other help you may need.
• Transportation essentials ― up to six round trips to the Social Security office, senior centers, group programs, Medicaid redetermination appointments, and Anthem health and education training classes.

You can redeem some benefits online through your Sydney Health secure account. You may need to complete activities like an online health screening or yearly wellness or dental visit to be eligible for certain extras. View the extra benefits you are eligible for on the Benefit Reward Hub or call the Member Services number on the back of your member ID card.

Log in to get started today.

Referrals

A referral is when your primary medical provider (PMP) sends you to another provider for care. This care is often from a specialist. Your PMP may send you to a specialist for special care or treatment. Your PMP can:

• Help choose a specialist to give you the care you need.
• Help you set the day and time for the office visit with a specialist.
• Ask Anthem if you can get services from a specialist. Your PMP knows when to ask for a prior authorization. (See below.)

Some types of services are known as self-referral services. That means you can get these services without a referral from your PMP. You can see any Indiana Health Coverage Programs (IHCP) doctor for many of these services. See your member handbook for a list of these services.

Prior authorization

Some services require prior authorization, or OK, from Anthem. Your PMP will ask Anthem to make sure they’re offered. If they are, both Anthem and your PMP or specialist agree the services are medically necessary. 

Getting a prior authorization will take no more than five business days or, if urgent, no more than 48 hours.

These are types of services, if offered in your health plan, that need prior authorization:

• Non-emergency air ambulance 
• Certain behavioral health services 
• Biofeedback 
• Drug injections 
• Certain dental services 
• Some equipment 
• Genetic testing 
• Home health and hospice care 
• Hyperbaric oxygen therapy 
• Infusion therapy and chemotherapy 
• Inpatient hospital services 
• Certain laboratory tests 
• Services not in your plan 
• Referrals to specialists 
• Radiology services 
• Select outpatient surgeries/procedures 
• Sensory integration therapy 
• Transplant services 
• Certain vision services 

Your PMP will know which services need prior authorization. We may not approve payment for a service you or your doctor asks for. If your case doesn’t meet the rules for medically needed, we’ll send you a letter. The letter will tell you we could not authorize the service and why. The letter will also let you know how to appeal our decision if you disagree with it. For more help, please call Member Services at 833-412-4405 (TTY 711).