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.

ValueOptions Provider Network

For mental health services, Lineco has an agreement with the ValueOptions 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 ValueOptions Provider.

You can save money by using providers in the ValueOptions 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 ValueOptions Provider Network. No deductibles apply under the In-Network Schedule and the payment percentage payable by the Plan is higher for some types of services.

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

Important: No benefits are payable under either the In-Network Schedule or the Out-of-Network Schedule unless the treatment is precertified by ValueOptions. You or your doctor must call ValueOptions before any type of treatment or psychological testing for substance abuse and mental or nervous disorders begins.

Call 1-800-332-2191 for precertification of ALL mental health & substance abuse claims.

MENTAL HEALTH
(All services must be pre-authorized by ValueOptions prior to receiving treatment)

Summary of Benefits

In this section, "In-Network"; means the ValueOptions Network—not the Blue Card PPO Network.
IN-NETWORK SCHEDULE
OUT-OF-NETWORK SCHEDULE
FULL-TIME INPATIENT CONFINEMENT:
Individual calendar year deductible
None
$250
Family calendar year deductible
None
$500
Maximum allowable days of confinement per person during a calendar year (or for a single confinement)
- 45 days -
(In- & Out-of-Network combined)
Plan payment percentage
80%
80%
PARTIAL INPATIENT CARE (DAY CARE):
Maximum allowable days per calendar year
- 75 days -
(In- & Out-of-Network combined)
Plan payment percentage
80%
80%
OUTPATIENT TREATMENT:
(Plan payment percentages per course of treatment)
First 8 visits
90%
80%
All subsequent visits .
90%
50%



SUBSTANCE ABUSE
(All services must be pre-authorized by ValueOptions prior to receiving treatment)

Overview

Benefits for treatment of substance abuse are payable for three types of treatment: inpatient rehabilitative treatment (including inpatient detoxification), intensive outpatient treatment, and regular (non-intensive) outpatient treatment.

You must complete the course of treatment to receive benefits. No benefits will be paid for any part of an inpatient or intensive outpatient course of treatment that is terminated before the course of treatment is completed, unless the course of treatment is terminated in order to participate in an outpatient program precertified by ValueOptions.

Summary of Benefits

In this section, "In-Network" means the ValueOptions Network, not the Blue Card PPO Network.
IN-NETWORK SCHEDULE
OUT-OF-NETWORK SCHEDULE
CALENDAR YEAR DEDUCTIBLE per person (for all treatment for substance abuse)
None
$250
INPATIENT TREATMENT:
Lifetime maximum allowable number of inpatient confinements per person
- Two -
(In- & Out-of-Network combined)
Maximum allowable number of days per confinement
- 21 days -
(In- & Out-of-Network combined)
Plan payment percentage
80%
80%
INTENSIVE OUTPATIENT TREATMENT:
Lifetime maximum allowable days of treatment per person
- 45 days -
(In- & Out-of-Network combined)
Plan payment percentage
90%
80%
NON-INTENSIVE OUTPATIENT TREATMENT:
Calendar year maximum benefit payable per person (including family and group therapy)
- $3,000 -
(In- & Out-of-Network combined)
Plan payment percentage.
90%
80%