Central California Alliance for Health

Members| Miembros| Cov Tswvcuab| Providers| About Us

Summary of Covered Services for Alliance Medi-Cal

Members with a Share of Cost must meet it each month before becoming eligible for benefits.

Note: Some links on this page may require Adobe Reader

• Services must be obtained from a Medi-Cal Participating provider

• Read the Member Handbook/EOC 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

  Provider Directory (Merced)

  Member Handbook

  Where to apply for benefit coverage

Category Description	Comments and Limitations
HOSPITAL SERVICES
Inpatient Room and Services Inpatient physical, occupational and speech therapy Intermediate or Skilled Nursing Services Emergency Room (covers visits in and out of the plan’s service area and with non-participating providers)	All non-emergency hospital services require prior authorization. You may be billed for or asked to pay at time of service from out-of-area, providers who do not participate in Medi-Cal
PROFESSIONAL SERVICES
PHYSICIAN SERVICES Office Visits Physician services in the hospital Outpatient surgery Immunizations Periodic Physical Examinations
PREGNANCY AND MATERNITY CARE Prenatal care (office visits) Normal delivery, cesarean section, complications of pregnancy, and medical services
OTHER HEALTH CARE SERVICES
AMBULANCE SERVICES
BLOOD AND BLOOD PRODUCTS (includes collection and storage of autologous blood)
DENTAL	Covered through Denti-Cal (1-800-322-6384), not the Alliance. These members are able to see any Denti-Cal provider: members who are under 21 years of age; residing in a skilled or intermediate nursing care facility; or beneficiaries who are pregnant, if not receiving the services could harm the health of the mother or the fetus. Members who are 21 or older who do not meet the above criteria must get services from a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC) provider unless Denti-Cal authorized services from another provider.
DIAGNOSTIC X-RAY/LAB PROCEDURES
DURABLE MEDICAL EQUIPMENT (including original and replacement orthotics and prosthetics)
FAMILY PLANNING SERVICE Medical, Professional and Counseling Services FDA Approved Contraceptive drugs and devices	Covers some FDA approved over-the-counter items such as condoms, foams and jellies.
HEARING AIDS Audiology Exam and Hearing Aid Instrument
HOME HEALTH CARE
HOSPICE (for a terminal illness)
ACUPUNCTURE AND CHIROPRACTIC SERVICES	Members who are under 21 years of age or who are residing in a skilled or intermediate nursing care facility may get up to two services per month.
MENTAL HEALTH SERVICES	Covered through County Mental Health Departments, not the Alliance Santa Cruz County: 1.800.952.2335 Monterey County: 1.888.258.6029 Merced County: 1.888.334.0163
NON-EMERGENCY MEDICAL TRANSPORTATION	Benefit limited to transportation to and from covered medical apppointments for members who: • Have a physical or medical condition that prevents them from riding in a bus or car; • Must be transported lying down; • Are in a wheelchair and not able to move out of the chair into a seat or to push the chair themselves. Members who feel they meet the above criteria should call 800-700-3874 ext. 5625.
PRESCRIPTION DRUGS 30-day supply. 90-day supply for maintenance drugs.	Members must get their prescriptions at a network pharmacy. Dual eligible Alliance members (members with both Medicare and Medi-Cal) must receive the majority of their prescriptions through their Medicare Part D drug plan or Medicare Advantage Plan. There are a few classes of drugs that are excluded from Medicare Part D that the Alliance would still be responsible for.
REHABILITATIVE (PHYSICAL, OCCUPATIONAL AND SPEECH) THERAPY	The initial evaluation visit requires a referral from the member’s Primary Care Provider. Any subsequent visits/treatments would require prior authorization from the Alliance.
SUBSTANCE ABUSE SERVICES	Covered under fee-for-service Medi-Cal, not the Alliance
URGENT CARE	Covered by or arranged by your PCP
VISION	Members who are under 21 years of age or who are residing in a skilled or intermediate nursing care facility are able to get an eye exam and glasses every two years. All other Alliance Medi-Cal members are covered only for an eye exam every two years. Glasses are not a covered benefit for these members.. Vision services for Alliance members are provided through Vision Services Plan (VSP) at 1-800-438-4560.