Summary of Covered Services for Medi-Cal Access Program - AIM

Benefit year October 1 - September 30

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• Services must be obtained from a participating provider. 

• Read the Evidence of Coverage for Specific Benefits.


• Benefits are subject to Alliance Utilization Management.

Follow the links for more information about your health plan and coverage:

 

  Health Education Benefits

  Provider Directory

  Member Handbook

  Where to apply for benefit coverage



Category Description Member Copayment & Limitations
HOSPITAL SERVICES  

Inpatient Room and Services

Inpatient physical, occupational and speech therapy

Emergency Room (services in and out of the plan’s service area and with non-participating providers)


Skilled Nursing (limited to 100 days/ benefit year)

No Copayment

No Copayment


No Copayment




No Copayment
PROFESSIONAL SERVICES  

PHYSICIAN SERVICES
Office Visits

Physician services in the hospital

Outpatient surgery

Immunizations


Periodic Physical Examinations


No Copayment

No Copayment

No Copayment

No Copayment


No Copayment
PREGNANCY AND MATERNITY CARE

Prenatal care (office visits)


Normal delivery, cesarean section, complications of pregnancy, and medical services

No Copayment

No Copayment

OTHER HEALTH CARE SERVICES  
ACUPUNCTURE (20 visits per benefit year) No Copayment
AMBULANCE SERVICES No Copayment
BLOOD AND BLOOD PRODUCTS (includes collection and storage of autologous blood) No Copayment
CHIROPRACTIC (20 visits per benefit year) No Copayment
DIAGNOSTIC X-RAY/LAB PROCEDURES No Copayment
DURABLE MEDICAL EQUIPMENT
(including original and replacement orthotics and prosthetics)
No Copayment
FAMILY PLANNING SERVICE

Medical, professional and counseling services


FDA Approved Contraceptive drugs and devices prescribed by your doctor
No Copayment


No Copayment
HEARING AIDS             
Audiology Exam

Hearing Aid Instrument

 

No Copayment


No Copayment
HOME HEALTH CARE No Copayment
HOSPICE (for a terminal illness) No Copayment
MENTAL HEALTH

Inpatient

Outpatient


 

No Copayment

No Copayment
Covered through OptumHealth at
1-800-808-5796.
Or visit their site at www.liveandworkwell.com

REHABILITATIVE (SPEECH, PHYSICAL AND OCCUPATIONAL) THERAPY
In office or through home health care
No Copayment
PRESCRIPTION DRUGS

30-day supply


90-day supply for Maintenance Drugs

No Copayment


No Copayment

SUBSTANCE ABUSE TREATMENT SERVICES

No Copayment
Covered through OptumHealth at
1-800-808-5796.
Or visit their site at www.liveandworkwell.com

URGENT CARE SERVICES No Copayment. Must be provided/arranged by your PCP.

 

 

There are no deductibles or lifetime maximum limits under this plan.

 

 

 

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