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Healthy Indiana Plan

HIP > For HIP Providers > Order HIP Materials Order HIP Materials

 

To Order Healthy Indiana Plan (HIP) Materials:

Required Information:

  1. Deliver to: Use your Address and Room Number
  2. Requested By: Enter the Name and Telephone Number of the Contact Person

Note:

  1. The Request Number is for your records
  2. The Account Number is for your Financial Account (as applicable)

Contact Information:

Current HIP Materials:

 State ID Number  Other Number  Name/Title (Description)
 53421  HIP 2515  Healthy Indiana Plan Application (English)
 53422  HIP 2515S  Healthy Indiana Plan Application (Spanish)
 N/A  FSSA 1007  Healthy Indiana Plan Brochure (English)
 N/A  HIP 1150S  Healthy Indiana Plan Brochure (Spanish)