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IHN BenefitsAs an Oregon Health Plan member you have one of two benefit packages: OHP Plus or OHP Standard. To find out which benefit package you are eligible for, refer to your mauve and white OMAP Medical care ID. The following IHN benefits are not available to all members. If you have the OHP Plus benefit package these services are fully covered. If you have the OHP Standard benefit package your benefits are limited. Click on OHP Standard Benefits and Copayments for a list of covered services. Vision CareIHN will pay for a routine vision exam and new glasses once every 12 months for members who are 20 years and younger. IHN will pay for a routine vision exam and new glasses once every two years for adults. Call your PCP about other problems, such as injury or infection. Your PCP will refer you to specialty care if needed. Note: Some people should have vision exams more often. For example, people with diabetes should have a vision exam every year. We will pay for any extra care you need, as long as you have an authorized referral from your PCP. Hearing Aid ServicesIHN pays for hearing tests, hearing aids and batteries. If you are in need of hearing services, call our ENCCs at 1-800-757-5114 or TTY 1-800-735-2900. Skilled Nursing Facility Care (SNF)Skilled Nursing Facility (SNF) care is covered up to 20 days following hospitalization when medically necessary. Medicaid or Medicare may cover additional SNF care. Laboratory Tests, X-Rays and Other ProceduresThese services are covered if they are medically necessary and if your PCP orders them. Prescription MedicationsPlease check you IHN Member ID card for your prescription drug benefit coverage. Some copays may apply. IHN does not pay for mental health prescriptions. These are paid for by OMAP and may be subject to a copayment. IHN will pay for most prescription and over-the-counter medications if you have a prescription from your PCP. You may fill prescriptions at almost any pharmacy in Benton or Linn counties. Just ask your favorite pharmacy if they accept IHN! IHN uses a “formulary” for prescription drugs. A formulary is a list of covered prescription drugs. All IHN providers have a copy of this formulary in their offices. When you need a prescription, your PCP will choose a drug from the formulary. Drugs that are not on the list are called non-formulary. If you need a drug that is not on the IHN formulary, your PCP can appeal the formulary. A Medical Director or a team of doctors will decide if it is medically necessary for you to have a drug that is non-formulary. If there is a high medical need for the prescription, we will pay for the non-formulary drug. |
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