Summary of Covered Services for AIM
Benefit year October 1 - September 30
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• Services must be obtained from a participating plan provider • Benefits are subject to Alliance Utilization Management |
Follow the links for more information about your health plan and coverage:
Health Education Benefits |
| Category Description | Member Copayment & Limitations |
|---|---|
| HOSPITAL SERVICES | |
Inpatient Room and Services Skilled Nursing (limited to 100 days/ benefit year) |
No Copayment No Copayment |
| PROFESSIONAL SERVICES | |
PHYSICIAN SERVICES Periodic Physical Examinations |
No Copayment |
| PREGNANCY AND MATERNITY CARE
Prenatal care (office visits) Normal delivery, cesarean section, complications of pregnancy, and medical services |
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 (30 days per benefit year) Limits do not apply to services for severe mental illness (SMI) or serious emotional disturbance (SED)
|
No Copayment |
| 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. Call United Behavioral Health (UBH), 1-800-808-5796. |
| URGENT CARE SERVICES | No Copayment. Must be provided/arranged by your PCP. |
There are no deductibles or lifetime maximum limits under this plan.