The Health Plan provides coverage for chemical dependency treatment. Call ValueOptions at (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-authorized¹ treatment.
|
First course of treatment
- Coinsurance
- Failure to complete treatment penalty
| 95% of scheduled allowance for covered expenses
- 5% of allowable expenses
- 50% reduction in reimbursement
|
Second course of treatment
- Coinsurance
- Failure to complete treatment penalty
| 80% of scheduled allowance for covered expenses
- 20% of allowable expenses
- 60% reduction in reimbursement
|
Third course of treatment
- Coinsurance
- Failure to complete treatment penalty
| 60% of scheduled allowance for covered expenses limited to emergency admission for detoxification and outpatient treatment only
- 40% of allowable expenses
- 70% reduction in reimbursement
|
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1 All treatment for chemical dependency must be pre-authorized 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.
Refer to the 2011 Health Plan SPD 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.