Your Child is Covered Away at School
Alliance Health and Life
Alliance PPO Enrollees
PPO enrollees may receive medical care from any provider. If the provider is not Alliance-affiliated, the care is covered as out-of- plan. If the care is urgent or an emergency, it is covered at the in-plan benefit level.
Alliance EPO Enrollees
EPO enrollees may receive medical care from any affiliated provider. If the provider is not Alliance-affiliated, the care is not a covered benefit unless it is an urgent or emergency situation.
For EPA and POS members, the following services are covered at 100 percent only if they are received through the student's physician's hospital affiliation. If these services are received from a physician outside of the student's physician's hospital affiliation, he/ she will be responsible for the charges as described in the Group Health Insurance Policy and Riders.
- Routine physical exams
- Routine care for non-emergent conditions
- Non-emergent psychiatric care which can be arranged by calling Coordinated Behavioral Health Management (CBHM) at (800) 444-5755
- Gynecological services for chronic gynecologic conditions, and routine gynecological exams (routine gynecological services may be obtained from any Alliance affiliated gynecological provider). Obstetrical care for the diagnosis of pregnancy is not a covered benefit for dependents under Alliance.
- Sports medicine
- Non-emergent dermatology services
If time and the condition permits we recommend that students call our Referral Management Team at (313) 664-8950 to find out whether or not authorization is needed for covered care. Obtaining physician direction before receiving services will help to ensure that the appropriate authorizations are on file for claims processing.
*Coverage is not extended to dependent children who reside with a custodial parent outside the Alliance service area.