All mental health and substance abuse treatment benefits for indemnity plan and Pacificare enrollees are administered by PBH. Kaiser enrollees will receive Substance Abuse Treatment Plan through PBH, but will be entitled to mental health coverage administered through Kaiser facilities only. All treatment services must be pre-authorized (877) 225 2267 and participants are required to utilize network facilities and providers. Note that treatment assessments are available through PBH Member Assistance Plan counseling program and that the Plan provides three visits per year at no cost to the participant. More information concerning the network is available through the PBH website at www.pbhi.com. | |
|
Eligibility |
Member Assistance and Behavioral Health is provided through PacifiCare Behavioral Health Coverage described below and is covered in 4 categories.
- Member Assistance Program (MAP): covers all eligible participants and members of their household.
- Mental Health: covers eligible participants and their dependents who have opted for the Indemnity Plan or Pacificare (Kaiser participants receive this care through Kaiser).
- Chemical Dependency: covers all eligible participants and their dependents.
- Severe Mental Illness: (same as Mental Health)
|
|
| |
|
|
Member Assistance Program (MAP)
1-877-225-2267 |
This a free confidential counseling and referral service to help you assess a variety of personal problems and suggest ways to resolve them. The following types are examples of typical problems:
- stress, depression, anger management, grief, domestic violence
- child rearing and elder-care
- legal and financial problems
- substance abuse
|
|
| |
|
|
Covered Services |
- 24 hour, toll free phone access
- 1-3 face-to-face
MAP counseling session per calendar year
|
|
| |
|
|
Severe Mental Illness* | |
|
|
Inpatient Treatment |
- No deductible
- Unlimited days covered at 100% after any applicable admission fee
- Lifetime dollar maximum applied to medical plan lifetime dollar maximum
|
|
| |
|
|
|
|
Outpatient Treatment |
- Unlimited visits
- $0 co-pay per visit
-
|
|
| |
|
|
|
* Severe Mental Illness diagnoses include: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depressive Disorder, Panic Disorder, Obsessive Compulsive Disorder, Pervasive Developmental Disorders (Autism), Anorexia, Bulimia, and Serious Emotional Disturbances of Children.
Lifetime dollar maximum for Parity Diagnoses: applied to medical plan lifetime. | |
|
Chemical Dependency | |
|
|
Maximums |
- $25,000 annual
- $35,000 lifetime
|
|
| |
|
|
|
|
Inpatient, Residential and Day Treatment |
100% coverage |
|
| |
|
|
|
|
Outpatient Treatment |
|
|
| |
|
|
|
Mental Health | |
|
|
Deductibles |
|
|
| |
|
|
|
|
Inpatient, Residential and Day Treatment |
- Up to 30 days per calendar year
- 100% coverage after any applicable admission fee
|
|
| |
|
|
|
|
Outpatient Treatment |
- 30 visits per calendar year
- $0 co-pay per visit
|
|
| |
|
|
|
