Plan administration and utilization management programs have more effect on benefits received than a mere listing of the benefits offered. Setting aside cost sharing issues as the statute and regulations require, all three packages provide an ample and full set of benefits that the large majority of Alabamians would consider very attractive. All packages are essentially similar, though perhaps not identical, in the following respects. All packages are limited by general requirements of medical necessity and prohibitions on experimental or investigational treatment. All provide inpatient hospital care in semi-private rooms.
All packages cover inpatient surgical, medical, and maternity care.
All packages cover outpatient hospital, surgical, medical, emergency room, prescription drugs, durable medical equipment, routine vision screening, allergy services, and maternity care. SEIB describes well child visits through age 5 without an apparent limit but limits well child visits to every other year ages 6 through 17. Those cost sharing and utilization management provisions are so significant that a simple listing of benefits reveal little of the clinical usefulness of the benefits. MH MH up to 100 days per calendar year. Outpatient - up to 25 visits per calendar year.