Summary
of Benefits
The following outpatient benefits are covered under
the Californiakids Program: |
| |
Physician
Services
Including Primary Care, Specialty Care and Consultations |
| •
Office visits |
| •
Follow-up treatments |
| •
Specialist/consultants |
| •
X-rays |
| •
Outpatient laboratory services |
| •
Injectable medications (administered in doctor’s office) |
| |
Health
Maintenance and Wellness Services
Preventive
Care |
| •
Routine physicals and examinations (when ordered by your physician) |
| •
Vision and hearing examinations |
| •
Allergy testing and treatment (excluding serum and medication) |
| •
Specific immunizations |
| •
Health education |
| |
Outpatient
Services
Same-Day
Outpatient Surgery or Outpatient Diagnostic Services
|
| •
Outpatient
hospital services |
| •
Diagnostic
laboratory and radiology services |
| |
Emergency
Care
Provided for Emergencies Only |
| •
Emergency
Room Limit $1,000 per year |
| •
Outpatient
hospital services (no inpatient services) |
| |
| Ambulance
Services |
| •
Ground
or air ambulance transportation |
| |
| Inpatient
Services |
| •
Not a covered benefit |
| |
Prescription
Drugs
Prescriptions must be filled at participating
pharmacies |
| •
Brand
name |
| •
Generic |
| •
Mail
order |
| |
Vision
Services
Vision services must be approved by
SafeGuard Vision Plan |
| •
Eye
Examination |
| •
Lenses/Frames |
| •
Contact
Lenses |
| |
Dental
Services
Dental services must be approved by
SafeGuard Dental Plan |
| •
Preventive
Diagnostic and Restorative Services |
| |
Family
Assistance Program
Behavioral health services must be
approved by the Holman Counseling, Inc. |
| •
Face-to-face
evaluations with a licensed clinician at an office convenient
to your location |
| •
8
sessions are covered with a licensed clinician |
•
Easy
access to services and crisis counseling 24 hours a day, seven
days a week via a toll-free
telephone
number |
| |
| Personal
Health Advisor |
| •
24-hour
nurse hotline |
| •
Access to audio health library |
| |
|
|