Situation

CHOICE PLUS

NETWORK

CHOICE PLUS

NON-NETWORK

Vendor

United Behavioral Health

Employer Division

Call 1-877-348-9411

United Behavioral Health

Employer Division

Call 1-877-348-9411

Substance Abuse Services Inpatient or Intermediate

The Plan covers Substance Abuse Treatment which is:

●  Pre-authorized by the

Mental Health/Substance Abuse Administrator, who is responsible for coordinating all of your care; and

●  Received on an inpatient or intermediate care basis in a Hospital or an Alternate Facility which provides Substance Abuse Treatment.

Benefits include detoxification from abusive chemicals or substances when necessary to protect your health.

If there are multiple diagnoses, the Plan will only pay for treatment of the diagnoses which are identified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA). Benefits include detoxification from abusive chemicals or substances when necessary to protect your health. APA's website is www.apa.org.

If the MH/SA Administrator determines that an Inpatient Stay is required, it is covered on a semi-private room (a room with two or more beds) basis. At the sole discretion of the MH/SA Administrator, two sessions of intermediate care (such as partial hospitalization) may be provided in lieu of one inpatient day.

90% of eligible expenses.

Any combination of Network and Non-Network Benefits for Mental Health Services and/or Substance Abuse Services is limited to 52 days per Calendar Year.

Authorization Required

Please remember that you must call the Mental Health/Substance Abuse Administrator and get authorization to receive these Benefits in advance of any treatment. Please call the mental health services phone number that appears on your ID card.

Without authorization, you will be responsible for paying all charges and no Benefits will be paid.

80% of eligible expenses after satisfying $300 deductible.

Any combination of Network and Non-Network Benefits for Mental Health Services and/or Substance Abuse Services is limited to 52 days per Calendar Year.

Authorization Required

Please remember that you must call the Mental Health/Substance Abuse Administrator and get authorization to receive these Benefits in advance of any treatment. Please call the mental health services phone number that appears on your ID card.

Without authorization, you will be responsible for paying all charges and no Benefits will be paid.

Substance Abuse Services Outpatient

$35 copay then 100% of eligible expenses.

Any combination of Network and Non-Network Benefits for Mental Health Services and/or Substance Abuse Services is limited to 52 visits per Calendar Year.

Authorization Required

Please remember that you must call the Mental Health/Substance Abuse Administrator and get authorization to receive these Benefits in advance of any treatment. Please call the mental health services phone number that appears on your ID card.

Without authorization, you will be responsible for paying all charges and no Benefits will be paid.

80% of eligible expenses after satisfying $300 deductible.

Any combination of Network and Non-Network Benefits for Mental Health Services and/or Substance Abuse Services is limited to 52 visits per Calendar Year.

Authorization Required

Please remember that you must call the Mental Health/Substance Abuse Administrator and get authorization to receive these Benefits in advance of any treatment. Please call the mental health services phone number that appears on your ID card.

Without authorization, you will be responsible for paying all charges and no Benefits will be paid.