Alliance Benefit Summary

Extra Benefits and Services
  • Holiday Programs
  • Community Health Events
  • 24- Hour Nurse Advice Line
  • Mobile Van Community Outreach


Health Education & Programs

Monthly Education Classes including:
  • Overweight
  • High blood pressure
  • Controlling Diabetes Class
  • Monthly Newsletter and Materials
  • Health Check Program
  • Adopt a School Program
  • Immunization Initiative
  • Community Based Outreach Workers
  • One-on-One and Group Orientation
  • Community Contact
  • Application and Recertification Assistance


Alliance Basic Services

Summary of Benefits

  • Physician Care and Hospital care when you are sick or injured
  • Specialty Care when requested by your Primary Care Provider
  • Lab/X-ray
  • Preventive Care to avoid health problems before you are sick or injured
  • Urgent Care Services
  • Emergency Services
  • Rehabilitation Services (physical, occupational, speech therapy)
  • Home Health Care
  • Dental Services
  • Wellness Programs
  • Maternity Care
  • Family Planning (birth control), except infertility treatment


Transportation Services

  • Emergency Transportation Only


Dental

Adult Dental Services include:
  • Dental exams every six months
  • Simple surgical extractions (removal of teeth)
  • Emergency care
  • Fillings
  • Cleaning and fluoride treatments every six months
  • Space maintainers (partial dentures) as medically necessary
  • X-Rays
  • Dentures and denture repair

Please Note: Dentures will be limited to a new set every five years. More frequent replacements will need to be requested by your dentist and approved by Health Right-Alliance. In addition, under the Alliance Program dental services for Undocumented Children under 21 are provided according to the periodic screening schedule established by the District of Columbia, as shown below. Services are also provided at other times whenever a dental problem is expected. Covered services include all medically necessary dental care to restore teeth, maintain dental health, and treat dental emergencies.


Periodic Screening Schedule for Undocumented Children Under 21:

  • First dental appointment for DC HealthCare Alliance members at age three (3) with follow-up care provided every six (6) months for cleaning and/or fluoride treatment;
  • Bitewings and/or panoramic radiographs (X-rays to show teeth condition) every three years for DC HealthCare Alliance members age seven (7) and older.

Please Note: The dental benefit for undocumented children under 21 should effectively be limited to undocumented/non-qualified alien children 19-20; virtually all non-qualified alien children under 19 should be covered through the Immigrant Children's Program. The same applies to the Well-Child Care Program for Undocumented Children (see below).]


Oral Surgery

Health Right Alliance covers surgery for emergency repairs of accidental injury to the jaw, mouth, and teeth. Well-Child Care Program for Undocumented Children It is important that every child gets regular check-ups to make sure they stay healthy. Health Right’s Alliance Well-Child program provides free preventive healthcare for members from birth up to age 21. The Well-Child program covers healthcare services for sickness and injury, including hospitalization and also provides for periodic screening and regular check-ups. If your child's primary care provider finds any medical conditions that need more care, you or your family member will be referred to a specialist. You should make a Well-Child exam appointment as soon as possible for your dependent children. At your appointment, your child's provider can also fill out the 1/2008 school health forms for you. Most children not covered by private insurance are eligible for coverage through Medicaid. The primary exception is undocumented children who are eligible for the Alliance since they are not eligible for Medicaid. Well-Child Care regular check-ups include the following items depending on your child's age and sex:

  • Complete physical exam
  • Complete health history
  • Developmental review
  • Vision, hearing and dental review
  • Immunizations (shots)
  • Nutrition review
  • Help to plan for any health problems or
  • Measurements (blood pressure and other vital signs) concerns regarding your child
  • Laboratory procedures including lead screening


Family Planning Services

Family Planning Services is any medically appropriate procedure, treatment, counseling, drug, supply, or device which is prescribed or furnished by a Provider to members of childbearing age for the purpose of helping them determine the number and spacing of their children.

We encourage you to see your PCP for all of your basic health care needs. You have the right, however, to get family planning services from any D.C. family planning clinic of your choice. For a list of these family planning clinics, please call Member Services at 202-218-0380.

Summary of Family Planning Services:
  • All ages, no referral necessary
  • May use any qualified family planning provider
  • Education, counseling services
  • Birth control supplies, procedures, devices and drugs
  • Preventive exams and treatment
  • HIV testing and counseling
  • STD (Sexually Transmitted Disease) treatment

Exclusions and limitations:
  • Abortions (except when the life of the mother would be in danger or the pregnancy was the result of rape or incest)
  • Infertility treatment
  • Sterilization of patients under age 21


"An accreditation status of 'Commendable' from NCQA is a sign that a health plan is awarded to plans whose service and clinical quality meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement."

Margaret E. O'Kane
President of NCQA