Benefit Summary: MAP/Mental Health


Member Assistance Program (MAP)
1-(800)-332-2191

This a free confidential counseling and referral service to help you assess a variety of personal problems and suggest ways to resolve them. The MAP can help you and your family with all types of personal, emotional, work and family matters, including marital or family problems, childcare and elder-care, alcohol and/or substance abuse, emotional problems, depression, anxiety and stress, job dissatisfaction, family illness, and financial or legal concerns.

You can access the MAP by phone 24 hours a day, 365 days a year, free of charge. A MAP Care Manager will take your call, discuss the situation, and refer you to helpful resources in your community. If the MAP refers you to a local MAP counselor for in-office counseling, your first 6 visits will cost you nothing.



Beacon Health Options Provider Network

For mental health services, Lineco has an agreement with the Beacon Health Options Provider Network, a nationwide network of mental health hospitals, treatment facilities, doctors and professional mental health practitioners. Call 1-800-332-2191 to find a Beacon Health Options Provider.

You can save money by using providers in the Beacon Health Options Provider Network. Your benefits for treatment of substance abuse and mental or nervous disorders will be paid under the In-Network Schedule if the facility or counselor providing the treatment is a member of the Beacon Health Options Provider Network.

If you receive treatment from a facility or mental health practitioner who is NOT in the Beacon Health Options Provider Network, your benefits will be paid under the Out-of-Network Schedule, as long as the treatment has been precertified by Beacon Health Options.


Pre-Certification

Pre-certification by Beacon Health Options is not required for regular outpatient and office visits for mental health/substance abuse treatment. However:

  • You can and should continue to use the Beacon Health Options Member Assistance Program (MAP) for FREE visits and referrals. Remember, you must contact Beacon Health Options at 1-800-332-2191 before you see a counselor or psychiatrist in order to use your MAP benefits.
  • If you have Beacon Health Options provide referrals for your outpatient/office treatment, you can be sure you receive the higher in-network benefits.
  • Once you are in treatment, Beacon Health Options will work with your provider to assure that the plan of care is appropriate and medically necessary.

Precertification by Beacon Health Options is required for inpatient, residential, partial inpatient and intensive outpatient treatment, psychological testing, electroconvulsive therapy, and ABA therapy for autism. Call 1-(800)-332-2191 to precertify.

Call 1-800-332-2191 for precertification of inpatient mental health & substance abuse services.


BENEFITS
In general, starting January 1, 2012, benefits for mental health and substance abuse services will be paid at the same benefit levels as the Comprehensive Major Medical Program.



Summary of Benefits - Mental Health (Mental/Nervous Disorders)

Summary of Benefits
Mental Health (Mental/Nervous Disorders)
PPO Network Beacon Health Options provider network
Calendar Year Deductibles All treatment subject to regular major medical deductibles—$400/person, $1,200/family.
Emergency Room Deductible $150
Inpatient No day limits
80% PPO/70% non-PPO
Partial Inpatient (Day Care) No day limits
80% PPO/70% non-PPO
Outpatient First 8 Visits — 80% PPO/70% non-PPO
Subsequent Visits — 80% PPO/70% non-PPO
Out-of-Pocket Limit Coinsurance applies to out-of-pocket limit.
Precertification Requirement
  • inpatient
  • residential
  • partial inpatient/intensive outpatient
  • psychological testing
  • electroconvulsive therapy
  • ABA therapy for Autism
Precertification Non-Compliance Penalty Same as medical — $250 additional deductible for failure to precertify inpatient hospital treatment.
 
Plan may deny benefits for ANY treatment that is not determined to be medically necessary.
Provider Credentials
  • PPO — credentialed and participating with Beacon Health Options
  • Non-PPO — licensed MD, DO or clinical psychologist

(All Beacon Health Options PPO providers are covered, including Masters-level mental health providers such as social workers and counselors. Masters-level non-PPO providers are not covered.)





Summary of Benefits - Substance Abuse

Summary of Benefits
Substance Abuse
PPO Network Beacon Health Options provider network
Calendar Year Deductibles All treatment subject to regular major medical deductibles—$400/person, $1,200/family.
Emergency Room Deductible $150
Inpatient No limit on days or confinements.

Plan may cover incomplete treatment program but only if it is medically necessary and appropriate.

80% PPO/70% non-PPO cover incomplete treatment program but only if it is medically necessary and appropriate.

No disability benefits will be paid for non-completed program.

Intensive Outpatient No days limit
80% PPO/70% non-PPO
Outpatient 80% PPO/70% non-PPO
Out-of-Pocket Limit Coinsurance applies to out-of-pocket limit.
Precertification Requirement
  • inpatient
  • residential
  • partial inpatient/intensive outpatient
  • psychological testing
  • electroconvulsive therapy
  • ABA therapy for autism
Precertification Non-Compliance Penalty Same as medical—$250 additional deductible for failure to precertify inpatient hospital treatment.
Plan may deny benefits for ANY treatment that is not determined to be medically necessary.
Provider Credentials See Mental Health section above.
Acute Drug/Alcohol Usage Covered if medically necessary.