Health Care > Mental Health and Substance Abuse/EAP (2009)

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Mental Health and Substance Abuse (2009)

Plan at a Glance

$1,000 Deductible Plan¹	$300 Deductible Plan^1,3	Account Plan
*In-Network:* Plan pays 80%, you pay 20% *Out-of-Network:² Plan pays 60%, you pay 40% Out-of-Network:* Inpatient/intermediate and outpatient care limited to 30 days/visits per year. Inpatient substance abuse benefit limited to 40 days per lifetime.	*In-Network:* Plan pays 80%, you pay 20% *Out-of-Network:² Plan pays 60%, you pay 40% Out-of-Network:* Inpatient/intermediate and outpatient care limited to 30 days/visits per year. Inpatient substance abuse benefit limited to 40 days per lifetime.	*In-Network:* Plan pays 80%, you pay 20% *Out-of-Network:² Plan pays 60%, you pay 40% Out-of-Network:* Inpatient/intermediate and outpatient care limited to 30 days/visits per year. Inpatient substance abuse benefit limited to 40 days per lifetime.
Plan pays the above benefits after you meet your Medical Plan deductible. Pre-certification is only required for inpatient mental health or substance abuse care. If you live in a rural area where access to a Network is insufficient, you may be offered an Out-of-Area Plan with the same plan design but that allows you to seek care from any provider with claims paid at the in-network level. Reasonable and customary limits apply. Out-of-network benefits are limited to the reasonable and customary charge. You pay your regular out-of-network co-insurance plus any charges in excess of reasonable and customary. If you are offered $300 Deductible – MVP, $300 Deductible – WPS, $300 Deductible – Geisinger or $300 Deductible – Personal Care, benefits are the same as the Network $300 Deductible Plan.

$1,000 Deductible Plan¹

$300 Deductible Plan^1,3

Account Plan

In-Network:

Plan pays 80%, you pay 20%

Out-of-Network:²

Plan pays 60%, you pay 40%

Out-of-Network: Inpatient/intermediate and outpatient care limited to 30 days/visits per year. Inpatient substance abuse benefit limited to 40 days per lifetime.

In-Network:

Plan pays 80%, you pay 20%

Out-of-Network:²

Plan pays 60%, you pay 40%

Out-of-Network: Inpatient/intermediate and outpatient care limited to 30 days/visits per year. Inpatient substance abuse benefit limited to 40 days per lifetime.

In-Network:

Plan pays 80%, you pay 20%

Out-of-Network:²

Plan pays 60%, you pay 40%

Out-of-Network: Inpatient/intermediate and outpatient care limited to 30 days/visits per year. Inpatient substance abuse benefit limited to 40 days per lifetime.

Plan pays the above benefits after you meet your Medical Plan deductible. Pre-certification is only required for inpatient mental health or substance abuse care.

If you live in a rural area where access to a Network is insufficient, you may be offered an Out-of-Area Plan with the same plan design but that allows you to seek care from any provider with claims paid at the in-network level. Reasonable and customary limits apply.
Out-of-network benefits are limited to the reasonable and customary charge. You pay your regular out-of-network co-insurance plus any charges in excess of reasonable and customary.
If you are offered $300 Deductible – MVP, $300 Deductible – WPS, $300 Deductible – Geisinger or $300 Deductible – Personal Care, benefits are the same as the Network $300 Deductible Plan.

For more information, see MyBenefits Online.

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