Page 70 - EPO_Member_Kit

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The following services are covered at 100 percent only
if they are received through the student’s assigned
medical center/doctor’s network. If these services are
received from a doctor outside of the student’s
assigned medical center/doctor’s network they will be
covered at the higher out-of-plan benefit level. See
your Group Health Insurance Policy and Riders for the
specific coverage.
• Routine care for non-emergency conditions
• Routine physical exams
• Non-emergency psychiatric care which can be
arranged by calling Coordinated Behavioral
Health Management (CBHM) toll-free at
(800) 444-5755
• Gynecological services for pregnancy, chronic
gynecologic conditions and routine gynecological
exams (routine gynecological services may be
obtained from any Alliance-affiliated
gynecological provider). Obstetric care for the
diagnosis of pregnancy is not a covered benefit
for Alliance dependent children
• Sports medicine
• Non-emergency dermatology services
S T U D E N T S A W A Y A T S C H O O L – c o n t i n u e d
©2011 Alliance Health and Life Insurance Company