Mental Health Benefits
Payable at 90%
Inpatient mental health care with a limit of $30,000 per year and $60,000 per lifetime not to exceed 60 days per lifetime. The defined deductibles under the plan apply.
Payable at 50%
Outpatient psychotherapy charges up to a maximum of $1,200 per person per year pursuant to the use of a covered provider as described above. A partial hospitalization program as pre-approved by the claim administrator is considered outpatient care and is subject to the same provisions as outpatient psychotherapy coverage. The defined deductibles under the plan apply.
Substance Abuse Treatment
Substance abuse treatment facilities must be approved by the Claim Administrator. The maximum covered expenses for substance abuse treatment will be the prevailing ConsumerCare charges for such services. It does not include health resorts, rest homes or nursing homes.
Inpatient and outpatient treatment for substance abuse is subject to the plan deductible and is then covered under the same provisions and restrictions as mental health care. The treatment must take place at a facility approved by the Claim Administrator as described above. The coverage limit for inpatient substance abuse treatment is $30,000 per year and $60,000 per lifetime not to exceed 60 days per lifetime. The coverage limit for outpatient substance abuse treatment is $1,200 per person per year.
Treatment specifically for substance abuse is not defined as mental health care under the plan and therefore those benefits are not directly applied to the coverage limits for mental health care.