Mental Health Benefits. Benefits for items or services for mental health conditions, as defined by EOHHS and in accordance with applicable Federal and State law. For purposes of this Agreement, substance use disorder benefits include the long-term care services described in Attachment O – Mental Health, Substance Use and Developmental Disability Services for Children and Attachment P – Behavioral Health and Substance Use Services for Adults. [42 C.F.R. § 438.900]
Mental Health Benefits. The charges for the diagnosis and treatment of mental Illness, as that term is defined in Title 22, Guam Code Annotated, Section 28103, subject to the same conditions and restrictions applicable to physical Illness.
Mental Health Benefits. Blue Shield’s Mental Health Service Administrator (MHSA) arranges and administers Mental Health Services for Blue Shield Members within California. See the Out-Of- Area Program, BlueCard Program section for an explanation of how payment is made for out of state services. All Non-Emergency inpatient Mental Health Services, in- cluding Residential Care and Non-Routine Outpatient Mental Health Services are subject to the Benefits Management Pro- gram and must be prior authorized by the MHSA. See the Benefits Management Program section for complete infor- mation.
Mental Health Benefits. A Member is covered for services for the treatment of the following Mental or Behavioral Conditions through Participating Behavioral Health Providers.
1. Outpatient benefits are covered for short-term, outpatient evaluative and crisis intervention or home health mental health services, and are subject to the maximum number of visits, if any, shown on the Schedule of Benefits.
2. Inpatient benefits may be covered for medical, nursing, counseling or therapeutic services in an inpatient, non-hospital residential facility, appropriately licensed by the Department of Health or its equivalent. Coverage, if applicable, is subject to the maximum number of days, if any, shown on the Schedule of Benefits.
3. Inpatient benefit exchanges are a Covered Benefit. When authorized by HMO, 1 mental health inpatient day, if any, may be exchanged for up to 4 outpatient or home health visits. This is limited to an exchange of up to a maximum of 10 inpatient days for a maximum of 40 additional outpatient visits. One inpatient day, if any, may be exchanged for 2 days of treatment in a Partial Hospitalization and/or outpatient electroshock therapy (ECT) program in lieu of hospitalization up to the maximum benefit limitation upon approval by HMO. Requests for a benefit exchange must be initiated by the Member’s Participating Behavioral Health Provider under the guidelines set forth by the HMO. Member must utilize all outpatient mental health benefits, if any, available under the Certificate and pay all applicable Copayments before an inpatient and outpatient visit exchange will be considered. The Member’s Participating Behavioral Health Provider must demonstrate Medical Necessity for extended visits and be able to support the need for hospitalization if additional visits were not offered. Request for exchange must be pre-authorized by HMO.
4. Biologically-based mental or nervous conditions. Member shall be covered for outpatient and inpatient medical treatment and diagnosis of a biologically-based mental or nervous condition as defined by the most recent edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders”. Member shall be covered, subject to the same terms and conditions as physical illness upon diagnosis of one or more of the following conditions by a Participating Provider:
a. Schizophrenia;
b. Bipolar disorders;
c. Pervasive developmental disorder, or autism;
d. Paranoia;
e. Panic disorder;
f. Obsessive-compulsive disorder; ...
Mental Health Benefits. A Member is covered for services for the treatment of the following Mental or Behavioral Conditions through Participating Behavioral Health Providers.
1. Outpatient benefits are covered for short-term, outpatient evaluative and crisis intervention or home health mental health services, and are subject to the maximum number of visits, if any, shown on the Schedule of Benefits.
2. Inpatient benefits may be covered for medical, nursing, counseling or therapeutic services in an inpatient, Hospital or non-hospital residential facility, appropriately licensed by the Department of Health or its equivalent. Coverage, if applicable, is subject to the maximum number of days, if any, shown on the Schedule of Benefits.
Mental Health Benefits. Blue Shield’s Mental Health Service Administrator (MHSA) arranges and administers Mental Health Services for Blue Shield Members within California. See the Out- Of- Area Program, BlueCard Program section for an expla- nation of how payment is made for out of state services. All Non-Emergency inpatient Mental Health Services, in- cluding Residential Care and Non-Routine Outpatient Men- tal Health Services are subject to the Benefits Management Program and must be prior authorized by the MHSA. See the Benefits Management Program section for complete in- formation. Benefits are provided for professional (Physician) office visits for the diagnosis and treatment of Mental Health Con- ditions in the individual, family or group setting. Benefits are provided for Outpatient Facility and profes- sional services for the diagnosis and treatment of Mental Health Conditions. These services may also be provided in the office, home, or other non-institutional setting. Non- Routine Outpatient Mental Health Services include, but may not be limited to, the following:
Mental Health Benefits. Blue Shield’s Mental Health Service Administrator (MHSA) arranges and administers Mental Health Services for Blue Shield Members within California. See the Out-Of- Area Program, BlueCard Program section for an explanation of how payment is made for out of state services. All Non-Emergency inpatient Mental Health Abuse Services, including Residential Care, and Non-Routine Outpatient Mental Health Services are subject to the Benefits Manage- ment Program and must be prior authorized by the MHSA. See the Benefits Management Program section for complete information. Benefits are provided for professional (Physician) office vis- its for the diagnosis and treatment of Mental Health Condi- tions in the individual, family or group setting. Benefits are provided for Outpatient Facility and professional services for the diagnosis and treatment of Mental Health Conditions. These services may also be provided in the of- fice, home, or other non-institutional setting. Non-Routine Outpatient Mental Health Services include, but may not be limited to, the following:
Mental Health Benefits. I understand that if I am using my health insurance benefits to pay for mental health treatment, and/or substance abuse treatment, my insurance program may need some information from my clinician(s). The information that insurance companies need for initial sessions of outpatient treatment is limited to diagnosis, and type of treatment. However, if my outpatient treatment is to go beyond those initial sessions, then my insurance company will need additional information. If I am going to receive mental healthcare as an outpatient, I understand that my insurance company may have limits on the number of visits that it will pay for. I need to stay informed of my plan’s mental health benefits. If I am going to receive mental health treatment as an inpatient, my insurer will request information from my clinicians about my hospitalization. This additional information allows my insurer to determine if the treatment is medically necessary and if payment for treatment will be authorized. MR 0446 IP-OP (Rev. 03/15) Page 1 of 2 MR0446 hospital and at home. Examples of DME include nebulizers, wheelchairs and blood pressure monitors. I understand that it is my responsibility to obtain any DME that my healthcare professional says that I need. I am responsible for any and all costs not covered by insurance.
Mental Health Benefits. A Member is covered for services for the treatment of the following Mental or Behavioral Conditions as defined in the Definitions section of the Certificate and provided through Participating Behavioral
1. Outpatient benefits are covered for short-term, outpatient evaluative and crisis intervention or home health mental health services, and are subject to the maximum number of visits, if any, shown on the Schedule of Benefits.
Mental Health Benefits. Outpatient As necessary 90% of network rates 10% co-pay As necessary 50% of network rates Check with your HMO Alcohol & Chemical Dependency Benefits –Inpatient Covered 100% 4 Halfway House 100% Covered 50% 4 Halfway House 50% Check with your HMO; Inpatient services subject to deductible. Alcohol & Chemical Dependency Benefits -Outpatient $3,500 per calendar year 90% of network rates 10% co-pay 5 $3,500 per calendar year 50% of network rates 5 Check with your HMO 2 Deluxe hearing aids are covered at the same rate as basic hearing aids with the member paying the remainder. Discount hearing aids are offered through the XXX XXX. 0 Xxxxxxxxx days may be utilized for partial day hospitalization (PHP) at 2:1 ratio. One inpatient day equals two PHP days.
