Common use of Mental Health Benefits Clause in Contracts

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; or g. Major depressive 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. 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 approved in writing by HMOHMO prior to utilization. 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; or g. Major depressive 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. 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. 4. 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; or g. Major depressive 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. 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 (1) 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 Aetna U.S. Healthcare Inc. and state law have established standards to assure the competence and professional conduct of mental health service providers, to guarantee your right to informed consent to treatment, to assure the privacy of your medical information, to enable you to know which services are covered under this plan and to know the limitations on your coverage. If you would like a more detailed description than is provided here of covered benefits for mental health services under this plan, or nervous conditionsif you have a question or concern about any aspect of your mental health benefits, please contact us at the toll free number listed on your ID Card. Member shall be covered for outpatient and inpatient medical treatment and diagnosis of a biologically-based mental If you would like to know more about your rights under the law, 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 if you think anything you received from this plan may not conform to the same terms and conditions as physical illness upon diagnosis of one your contract or more your rights under the law, you may contact the Office of Insurance Commissioner at 000-000-0000. If you have a concern about the following conditions by a Participating Provider: a. Schizophrenia; b. Bipolar disorders; c. Pervasive developmental disorderqualifications or professional conduct of your mental health service provider, or autism; d. Paranoia; e. Panic disorder; f. Obsessiveplease call the State Health Department at 0-compulsive disorder; or g. Major depressive disorder000-000-0000.

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 is 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 (1) 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 approved in writing by HMOHMO prior to utilization. 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; or g. Major depressive 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. 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 the medical treatment and diagnosis of a biologically-based mental or nervous condition as defined by Serious Mental Illness. The diagnostic criteria set out in the most recent edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders”Disorders shall be utilized to determine a Serious Mental Illness. Member shall be covered, subject to covered under the same terms and conditions as and which are no less extensive than coverage provided for any other type of health care for physical illness upon diagnosis of one or more of the following conditions by a Participating Provider: a. Schizophrenia; b. Bipolar disorders;disorder c. Pervasive developmental Obsessive-compulsive disorder d. Major depressive disorder, or autism; d. Paranoia; e. Panic disorder; f. Obsessive-compulsive disorder; orAnorexia nervosa g. Major depressive Bulimia nervosa h. Schizoaffective disorder. i. Delusional 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 is subject to the maximum number of visits, if any, shown on the Schedule of Benefits. A visit is defined as a minimum full 50-1 hour session. 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 (1) 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 approved in writing by HMOHMO prior to utilization. 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; or g. Major depressive disorder.