Health Plan at-a-glance: 
         Chemical Dependency
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The Health Plan provides coverage for Chemical Dependency treatment. Call ValueOptions at 1-800-704-1421 for information or to pre-certify services from Network Providers. You must use care providers that participate in the ValueOptions provider network in order to receive benefits.


Chemical Dependency
Benefit Details Coverage
Lifetime Maximum Three (3) courses of pre-certified¹ treatment.
First Course of Treatment
  • Maximum reimbursement
  • Coinsurance
  • Failure to complete treatment penalty
95% of allowable expenses up to $11,000.
  • $10,450
  • 5% of allowable expenses up to $550.
  • 50% reduction in reimbursement (up to $5,500).
Second Course of Treatment
  • Maximum reimbursement
  • Coinsurance
  • Failure to complete treatment penalty
80% of allowable expenses up to $8,000.
  • $6,400
  • 20% of allowable expenses up to $1,600.
  • 60% reduction in reimbursement (up to $3,200).
Third Course of Treatment²
  • Maximum reimbursement
  • Coinsurance
  • Failure to complete treatment penalty
60% of allowable expenses up to $6,000.
  • $3,600
  • 40% of allowable expenses up to $2,400.
  • 70% reduction in reimbursement (up to $1,800 cap).

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1 All treatment for chemical dependency must be pre-certified by ValueOptions, except in the case of emergency treatment which must be authorized within 72 hours of the commitment. A course of treatment will be considered ended if the individual goes without treatment for a 90-day period.
2 This reimbursement will be provided only for an emergency admission and detoxification and for outpatient treatment.

See pages 44-47 of the 2005 Health Plan Summary Plan Description and relevant Benefits Updates for additional information and details. The information provided above is summarized and is not a complete description of the actual terms and provisions of the Health Plan documents. If any conflict arises between this information and the Plan documents, or if any point is not discussed above or is only partially discussed, the Plan documents will govern in all cases.