Mental Health and Substance Abuse
Standard Option includes coverage for mental health and substance abuse treatments. Your cost-sharing responsibilities are no greater for these treatments than for other illnesses or conditions. Standard Option offers you the flexibility to choose to receive care by an in-network, Preferred provider or by an out-of-network, Non-preferred provider.
Outlined below is a summary of the mental health and substance abuse benefits provided under Standard Option. Please remember that all benefits are subject to the definitions, limitations, and exclusions defined in the Blue Cross and Blue Shield Service Benefit Plan brochure.
2012 Standard Option - Mental Health and Substance Abuse Benefits
What You Pay
| Services | Standard Option PPO Benefit | Standard Option Non-PPO Benefit* |
|---|---|---|
Professional services, including individual of group therapy, provided by licensed professional mental health and substance abuse practitioners. | $20 copayment for the visit (No deductible) | 35% of the Plan allowance
|
Inpatient Hospital — Precertification required | $250 per admission copayment Unlimited days | $350 per admission copayment for unlimited days, plus 35% of the Plan allowance (No deductible)
|
Outpatient Facility Care | Subject to the calendar year deductible (Individual or Family) 15% of the Preferred Provider Allowance | Subject to the calendar year deductible (Individual or Family)
|
Inpatient Professional Visits | Nothing (No deductible) | 35% of the Plan allowance
|
Outpatient Professional Care | 15% of the Preferred Provider Allowance | Subject to the calendar year deductible (Individual or Family) 35% of the Plan Allowance You may be responsible for the difference between the billed and the allowable amount. |
Page last updated: December 22, 2011