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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


  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)