Common use of Mental Health Care Clause in Contracts

Mental Health Care. This plan covers all of the following services:  Inpatient, residential treatment and outpatient care to manage or reduce the effects of the mental condition  Individual or group therapy  Family therapy as required by law  Physical, speech or occupational therapy for mental health conditions, such as autism spectrum disorders  Lab and testing  Take-home drugs you get in a facility In this benefit, outpatient visit means a clinical treatment session with a mental health provider. Alcohol and Drug Dependence (Also called “Chemical Dependency” or “Substance Abuse”) This plan covers all of the following services:  Inpatient and residential treatment and outpatient care to manage or reduce the effects of the alcohol or drug dependence  Individual, family or group therapy  Lab and testing  Take-home drugs you get in a facility Applied Behavioral Analysis (ABA) Therapy This plan covers Applied Behavioral Analysis (ABA) Therapy. The member must be diagnosed with one of the following disorders:  Autistic disorder  Autism spectrum disorder  Asperger's disorder  Childhood disintegrative disorder  Pervasive developmental disorder  Rett’s disorder Benefits must be provided by:  A physician (MD or DO) who is a psychiatrist, developmental pediatrician, or pediatric neurologist  A state-licensed psychiatric nurse practitioner (NP), advanced nurse practitioner (ANP) or advanced registered nurse practitioner (ARNP)  A state-licensed masters-level mental health clinician (e.g., licensed clinical social worker, licensed marriage and family counselor, licensed mental health counselor)  A state licensed occupational or speech therapist when providing ABA services  A state licensed psychologist  Licensed Community Mental Health or Behavioral Health agency that is also state certified for ABA  Board certified Behavior Analyst, licensed in states with behavior analyst licensure, otherwise, certified by the Behavior Analyst Certification Board  Therapy assistants/behavioral technicians/paraprofessionals; when services are supervised and billed by a licensed provider or BCBA Covered services include:  Direct treatment or direct therapy services for identified patients and/or family members when provided by a licensed provider, Board Certified Behavioral Analyst (BCBA), or therapy assistants who are supervised by a licensed provider or BCBA.  Also covered when performed by a licensed provider or BCBA:  Initial evaluation/assessment  Treatment review and planning  Supervision of therapy assistants  Communication/coordination with other providers or school personnel Please Note: Delivery of all ABA services for an individual may be managed by a BCBA or licensed provider who is called a Program Manager. The Mental Health, Behavioral Health and Substance Abuse benefit does not cover:  Training of therapy assistants/behavioral technicians/paraprofessionals (as distinct from supervision)  Accompanying the member/identified patient to appointments or activities outside of the home (e.g. recreational activities, eating out, shopping, play activities, medical appointments), except when the member/identified patient has demonstrated a pattern of significant behavioral difficulties during specific activities  Transporting the member/identified patient in lieu of parental/other family member transport  Assisting the member with academic work or functioning as a tutor, except when the member has demonstrated a pattern of significant behavioral difficulties during school work  Functioning as an educational or other aide for the member/identified patient in school  Provision of services that are part of an IEP and therefore should be provided by school personnel, or other services that schools are obligated to provide  Provider doing house work or chores, or assisting the member/identified patient with house work or chores, except when the member has demonstrated a pattern of significant behavioral difficulties during specific house work or chores, or acquiring the skills to do specific house work or chores is part of the ABA treatment plan for the member/identified patient  Provider travel time  Babysitting  Respite for parents/family members  Provider residing in the member’s home and functioning as live-in help (e.g. in an au-pair role)  Peer-mediated groups or interventions  Training or classes for groups of parents of different patients  Hippotherapy/equestrian therapy  Pet therapy  Auditory Integration Therapy  Sensory Integration Therapy  Any other activity that is not considered to be a behavioral assessment or intervention utilizing applied behavior analysis techniques  Prescription drugs. These are covered under the Prescription Drugs benefit.  Treatment of sexual dysfunctions, such as impotence  Institutional care, except that services are covered when provided for an illness or injury treated in an acute care hospital  EEG biofeedback or neurofeedback  Family and marriage counseling or therapy, except when it is medically necessary to treat your mental condition  Therapeutic or group homes, xxxxxx homes, nursing homes boarding homes or schools and child welfare facilities  Outward bound, wilderness, camping or tall ship programs or activities  Mental health tests that are not used to assess a covered mental condition or plan treatment. This plan does not cover tests to decide legal competence or for school or job placement.  Detoxification services that do not consist of active medical management. See Definitions.  Support groups, such as Al-Anon or Alcoholics Anonymous  Services that are not medically necessary. This is true even if a court orders them or you must get them to avoid being tried, sentenced or losing the right to drive.  Sober living homes, such as halfway houses  Residential treatment programs or facilities that are not units of hospitals, or that the state has not licensed or approved for residential treatment  Caffeine dependence

Mental Health Care. This plan covers all of the following services:  • Inpatient, residential treatment and outpatient care to manage or reduce the effects of the mental condition  • Individual or group therapy  • Family therapy as required by law  • Physical, speech or occupational therapy for mental health conditions, such as autism spectrum disorders  • Lab and testing  • Take-home drugs you get in a facility In this benefit, outpatient visit means a clinical treatment session with a mental health provider. Alcohol and Drug Dependence (Also called “Chemical Dependency” or “Substance Abuse”) This plan covers all of the following services:  • Inpatient and residential treatment and outpatient care to manage or reduce the effects of the alcohol or drug dependence  • Individual, family or group therapy  • Lab and testing  • Take-home drugs you get in a facility Applied Behavioral Analysis (ABA) Therapy This plan covers Applied Behavioral Analysis (ABA) Therapy. The member must be diagnosed with one of the following disorders:  • Autistic disorder  • Autism spectrum disorder  • Asperger's disorder  • Childhood disintegrative disorder  • Pervasive developmental disorder  • Rett’s disorder Benefits must be provided by:  • A physician (MD or DO) who is a psychiatrist, developmental pediatrician, or pediatric neurologist  • A state-licensed psychiatric nurse practitioner (NP), advanced nurse practitioner (ANP) or advanced registered nurse practitioner (ARNP)  • A state-licensed masters-level mental health clinician (e.g., licensed clinical social worker, licensed marriage and family counselor, licensed mental health counselor)  • A state licensed occupational or speech therapist when providing ABA services  • A state licensed psychologist  • Licensed Community Mental Health or Behavioral Health agency that is also state certified for ABA  • Board certified Behavior Analyst, licensed in states with behavior analyst licensure, otherwise, certified by the Behavior Analyst Certification Board  • Therapy assistants/behavioral technicians/paraprofessionals; when services are supervised and billed by a licensed provider or BCBA Covered services include:  • Direct treatment or direct therapy services for identified patients and/or family members when provided by a licensed provider, Board Certified Behavioral Analyst (BCBA), or therapy assistants who are supervised by a licensed provider or BCBA.  • Also covered when performed by a licensed provider or BCBA:  • Initial evaluation/assessment  • Treatment review and planning  • Supervision of therapy assistants  • Communication/coordination with other providers or school personnel Please Note: Delivery of all ABA services for an individual may be managed by a BCBA or licensed provider who is called a Program Manager. The Mental Health, Behavioral Health and Substance Abuse benefit does not cover:  • Training of therapy assistants/behavioral technicians/paraprofessionals (as distinct from supervision)  • Accompanying the member/identified patient to appointments or activities outside of the home (e.g. recreational activities, eating out, shopping, play activities, medical appointments), except when the member/identified patient has demonstrated a pattern of significant behavioral difficulties during specific activities  • Transporting the member/identified patient in lieu of parental/other family member transport  • Assisting the member with academic work or functioning as a tutor, except when the member has demonstrated a pattern of significant behavioral difficulties during school work  • Functioning as an educational or other aide for the member/identified patient in school  • Provision of services that are part of an IEP and therefore should be provided by school personnel, or other services that schools are obligated to provide  • Provider doing house work or chores, or assisting the member/identified patient with house work or chores, except when the member has demonstrated a pattern of significant behavioral difficulties during specific house work or chores, or acquiring the skills to do specific house work or chores is part of the ABA treatment plan for the member/identified patient  • Provider travel time  • Babysitting  • Respite for parents/family members  • Provider residing in the member’s home and functioning as live-in help (e.g. in an au-pair role)  • Peer-mediated groups or interventions  • Training or classes for groups of parents of different patients  • Hippotherapy/equestrian therapy  • Pet therapy  • Auditory Integration Therapy  • Sensory Integration Therapy  • Any other activity that is not considered to be a behavioral assessment or intervention utilizing applied behavior analysis techniques  • Prescription drugs. These are covered under the Prescription Drugs benefit.  • Treatment of sexual dysfunctions, such as impotence  • Institutional care, except that services are covered when provided for an illness or injury treated in an acute care hospital  • EEG biofeedback or neurofeedback  • Family and marriage counseling or therapy, except when it is medically necessary to treat your mental condition  • Therapeutic or group homes, xxxxxx homes, nursing homes boarding homes or schools and child welfare facilities  • Outward bound, wilderness, camping or tall ship programs or activities  • Mental health tests that are not used to assess a covered mental condition or plan treatment. This plan does not cover tests to decide legal competence or for school or job placement.  • Detoxification services that do not consist of active medical management. See Definitions.  • Support groups, such as Al-Anon or Alcoholics Anonymous  • Services that are not medically necessary. This is true even if a court orders them or you must get them to avoid being tried, sentenced or losing the right to drive.  • Sober living homes, such as halfway houses  • Residential treatment programs or facilities that are not units of hospitals, or that the state has not licensed or approved for residential treatment  • Caffeine dependence

Mental Health Care. This plan covers all of the following services:  • Inpatient, residential treatment and outpatient care to manage or reduce the effects of the mental condition  • Individual or group therapy  • Family therapy as required by law  • Physical, speech or occupational therapy for mental health conditions, such as autism spectrum disorders  • Lab and testing  • Take-home drugs you get in a facility In this benefit, outpatient visit means a clinical treatment session with a mental health provider. Alcohol and Drug Dependence (Also called “Chemical Dependency” or “Substance Abuse”) This plan covers all of the following services:  • Inpatient and residential treatment and outpatient care to manage or reduce the effects of the alcohol or drug dependence  • Individual, family or group therapy  • Lab and testing  • Take-home drugs you get in a facility Applied Behavioral Analysis (ABA) Therapy This plan covers Applied Behavioral Analysis (ABA) Therapy. The member must be diagnosed with one of the following disorders:  • Autistic disorder  • Autism spectrum disorder  • Asperger's ’s disorder  • Childhood disintegrative disorder  • Pervasive developmental disorder  • Rett’s disorder Benefits must be provided by:  • A physician (MD or DO) who is a psychiatrist, developmental pediatrician, or pediatric neurologist  • A state-licensed psychiatric nurse practitioner (NP), advanced nurse practitioner (ANP) or advanced registered nurse practitioner (ARNP)  • A state-licensed masters-level mental health clinician (e.g., licensed clinical social worker, licensed marriage and family counselor, licensed mental health counselor)  • A state state-licensed occupational or speech therapist when providing ABA services  • A state state-licensed psychologist  • Licensed Community Mental Health or Behavioral Health agency that is also state certified for ABA  • Board certified Behavior Analyst, licensed in states with behavior analyst licensure, otherwise, certified by the Behavior Analyst Certification Board  • Therapy assistants/behavioral technicians/technicians/ paraprofessionals; when services are supervised and billed by a licensed provider or BCBA Covered services include:  • Direct treatment or direct therapy services for identified patients and/or family members when provided by a licensed provider, Board Certified Behavioral Analyst (BCBA), or therapy assistants who are supervised by a licensed provider or BCBA.  • Also covered when performed by a licensed provider or BCBA:  • Initial evaluation/assessment  • Treatment review and planning  • Supervision of therapy assistants  • Communication/coordination with other providers or school personnel Please Note: Delivery of all ABA services for an individual may be managed by a BCBA or licensed provider who is called a Program Manager. The Mental Health, Behavioral Health and Substance Abuse benefit does not cover:  • Training of therapy assistants/behavioral technicians/paraprofessionals (as distinct from supervision)  • Accompanying the member/identified patient to appointments or activities outside of the home (e.g. recreational activities, eating out, shopping, play activities, medical appointments), except when the member/identified patient has demonstrated a pattern of significant behavioral difficulties during specific activities  • Transporting the member/identified patient in lieu of parental/other family member transport  • Assisting the member with academic work or functioning as a tutor, except when the member has demonstrated a pattern of significant behavioral difficulties during school work  • Functioning as an educational or other aide for the member/identified patient in school  • Provision of services that are part of an IEP and therefore should be provided by school personnel, or other services that schools are obligated to provide  • Provider doing house work or chores, or assisting the member/identified patient with house work or chores, except when the member has demonstrated a pattern of significant behavioral difficulties during specific house work or chores, or acquiring the skills to do specific house work or chores is part of the ABA treatment plan for the member/identified patient  • Provider travel time  • Babysitting  • Respite for parents/family members  • Provider residing in the member’s home and functioning as live-in help (e.g. in an au-pair role)  • Peer-mediated groups or interventions  • Training or classes for groups of parents of different patients  • Hippotherapy/equestrian therapy  • Pet therapy  • Auditory Integration Therapy  • Sensory Integration Therapy  • Prescription drugs. These are covered under the Prescription Drugs benefit • Any other activity that is not considered to be a behavioral assessment or intervention utilizing applied behavior analysis techniques  • Prescription drugs. These are covered under the Prescription Drugs benefitDrugs.  • Treatment of sexual dysfunctions, such as impotence  • Institutional care, except that services are covered when provided for an illness or injury treated in an acute care hospital  • EEG biofeedback or neurofeedback  • Family and marriage counseling or therapy, except when it is medically necessary to treat your mental condition  • Therapeutic or group homes, xxxxxx homes, nursing homes boarding homes or schools and child welfare facilities  • Outward bound, wilderness, camping or tall ship programs or activities  • Mental health tests that are not used to assess a covered mental condition or plan treatment. This plan does not cover tests to decide legal competence or for school or job placement.  • Detoxification services that do not consist of active medical management. See Definitions.  • Support groups, such as Al-Anon or Alcoholics Anonymous  • Services that are not medically necessary. This is true even if a court orders them or you must get them to avoid being tried, sentenced or losing the right to drive.  • Sober living homes, such as halfway houses  • Residential treatment programs or facilities that are not units of hospitals, or that the state has not licensed or approved for residential treatment  • Caffeine dependence

Mental Health Care. This plan covers all of the following services:  Inpatient, residential treatment and outpatient care to manage or reduce the effects of the mental condition  Individual or group therapy  Family therapy as required by law  Physical, speech or occupational therapy for mental health conditions, such as autism spectrum disorders  Lab and testing  Take-home drugs you get in a facility In this benefit, outpatient visit means a clinical treatment session with a mental health provider. Alcohol and Drug Dependence (Also called “Chemical Dependency” or “Substance Abuse”) This plan covers all of the following services:  Inpatient and residential treatment and outpatient care to manage or reduce the effects of the alcohol or drug dependence  Individual, family or group therapy  Lab and testing  Take-home drugs you get in a facility Applied Behavioral Analysis (ABA) Therapy This plan covers Applied Behavioral Analysis (ABA) Therapy. The member must be diagnosed with one of the following disorders:  Autistic disorder  Autism spectrum disorder  Asperger's ’s disorder  Childhood disintegrative disorder  Pervasive developmental disorder  Rett’s disorder Benefits must be provided by:  A physician (MD or DO) who is a psychiatrist, developmental pediatrician, or pediatric neurologist  A state-licensed psychiatric nurse practitioner (NP), advanced nurse practitioner (ANP) or advanced registered nurse practitioner (ARNP)  A state-licensed masters-level mental health clinician (e.g., licensed clinical social worker, licensed marriage and family counselor, licensed mental health counselor)  A state state-licensed occupational or speech therapist when providing ABA services  A state state-licensed psychologist  Licensed Community Mental Health or Behavioral Health agency that is also state certified for ABA  Board certified Behavior Analyst, licensed in states with behavior analyst licensure, otherwise, certified by the Behavior Analyst Certification Board  Therapy assistants/behavioral technicians/technicians/ paraprofessionals; when services are supervised and billed by a licensed provider or BCBA Covered services include:  Direct treatment or direct therapy services for identified patients and/or family members when provided by a licensed provider, Board Certified Behavioral Analyst (BCBA), or therapy assistants who are supervised by a licensed provider or BCBA.  Also covered when performed by a licensed provider or BCBA:  Initial evaluation/assessment  Treatment review and planning  Supervision of therapy assistants  Communication/coordination with other providers or school personnel Please Note: Delivery of all ABA services for an individual may be managed by a BCBA or licensed provider who is called a Program Manager. The Mental Health, Behavioral Health and Substance Abuse benefit does not cover:  Training of therapy assistants/behavioral technicians/paraprofessionals (as distinct from supervision)  Accompanying the member/identified patient to appointments or activities outside of the home (e.g. recreational activities, eating out, shopping, play activities, medical appointments), except when the member/identified patient has demonstrated a pattern of significant behavioral difficulties during specific activities  Transporting the member/identified patient in lieu of parental/other family member transport  Assisting the member with academic work or functioning as a tutor, except when the member has demonstrated a pattern of significant behavioral difficulties during school work  Functioning as an educational or other aide for the member/identified patient in school  Provision of services that are part of an IEP and therefore should be provided by school personnel, or other services that schools are obligated to provide  Provider doing house work or chores, or assisting the member/identified patient with house work or chores, except when the member has demonstrated a pattern of significant behavioral difficulties during specific house work or chores, or acquiring the skills to do specific house work or chores is part of the ABA treatment plan for the member/identified patient  Provider travel time  Babysitting  Respite for parents/family members  Provider residing in the member’s home and functioning as live-in help (e.g. in an au-pair role)  Peer-mediated groups or interventions  Training or classes for groups of parents of different patients  Hippotherapy/equestrian therapy  Pet therapy  Auditory Integration Therapy  Sensory Integration Therapy  Prescription drugs. These are covered under the Prescription Drugs benefit  Any other activity that is not considered to be a behavioral assessment or intervention utilizing applied behavior analysis techniques  Prescription drugs. These are covered under the Prescription Drugs benefitDrugs.  Treatment of sexual dysfunctions, such as impotence  Institutional care, except that services are covered when provided for an illness or injury treated in an acute care hospital  EEG biofeedback or neurofeedback  Family and marriage counseling or therapy, except when it is medically necessary to treat your mental condition  Therapeutic or group homes, xxxxxx homes, nursing homes boarding homes or schools and child welfare facilities  Outward bound, wilderness, camping or tall ship programs or activities  Mental health tests that are not used to assess a covered mental condition or plan treatment. This plan does not cover tests to decide legal competence or for school or job placement.  Detoxification services that do not consist of active medical management. See Definitions.  Support groups, such as Al-Anon or Alcoholics Anonymous  Services that are not medically necessary. This is true even if a court orders them or you must get them to avoid being tried, sentenced or losing the right to drive.  Sober living homes, such as halfway houses  Residential treatment programs or facilities that are not units of hospitals, or that the state has not licensed or approved for residential treatment  Caffeine dependence

Mental Health Care. This plan covers all of the following services:  Inpatient, residential treatment and outpatient care to manage or reduce the effects of the mental condition  Individual or group therapy  Family therapy as required by law  Physical, speech or occupational therapy for mental health conditions, such as autism spectrum disorders  Lab and testing  Take-home drugs you get in a facility In this benefit, outpatient visit means a clinical treatment session with a mental health provider. Alcohol and Drug Dependence (Also called “Chemical Dependency” or “Substance Abuse”) This plan covers all of the following services:  Inpatient and residential treatment and outpatient care to manage or reduce the effects of the alcohol or drug dependence  Individual, family or group therapy  Lab and testing  Take-home drugs you get in a facility Applied Behavioral Analysis (ABA) Therapy This plan covers Applied Behavioral Analysis (ABA) Therapy. The member must be diagnosed with one of the following disorders:  Autistic disorder  Autism spectrum disorder  Asperger's disorder  Childhood disintegrative disorder  Pervasive developmental disorder  Rett’s disorder Benefits must be provided by:  A physician (MD or DO) who is a psychiatrist, developmental pediatrician, or pediatric neurologist  A state-licensed psychiatric nurse practitioner (NP), advanced nurse practitioner (ANP) or advanced registered nurse practitioner (ARNP)  A state-licensed masters-level mental health clinician (e.g., licensed clinical social worker, licensed marriage and family counselor, licensed mental health counselor)  A state licensed occupational or speech therapist when providing ABA services  A state licensed psychologist  Licensed Community Mental Health or Behavioral Health agency that is also state certified for ABA  Board certified Behavior Analyst, licensed in states with behavior analyst licensure, otherwise, certified by the Behavior Analyst Certification Board  Therapy assistants/behavioral technicians/paraprofessionals; when services are supervised and billed by a licensed provider or BCBA Covered services include:  Direct treatment or direct therapy services for identified patients and/or family members when provided by a licensed provider, Board Certified Behavioral Analyst (BCBA), or therapy assistants who are supervised by a licensed provider or BCBA.  Also covered when performed by a licensed provider or BCBA:  Initial evaluation/assessment  Treatment review and planning  Supervision of therapy assistants  Communication/coordination with other providers or school personnel Please Note: Delivery of all ABA services for an individual may be managed by a BCBA or licensed provider who is called a Program Manager. The Mental Health, Behavioral Health and Substance Abuse benefit does not cover:  Training of therapy assistants/behavioral technicians/paraprofessionals (as distinct from supervision)  Accompanying the member/identified patient to appointments or activities outside of the home (e.g. recreational activities, eating out, shopping, play activities, medical appointments), except when the member/identified patient has demonstrated a pattern of significant behavioral difficulties during specific activities  Transporting the member/identified patient in lieu of parental/other family member transport  Assisting the member with academic work or functioning as a tutor, except when the member has demonstrated a pattern of significant behavioral difficulties during school work  Functioning as an educational or other aide for the member/identified patient in school  Provision of services that are part of an IEP and therefore should be provided by school personnel, or other services that schools are obligated to provide  Provider doing house work or chores, or assisting the member/identified patient with house work or chores, except when the member has demonstrated a pattern of significant behavioral difficulties during specific house work or chores, or acquiring the skills to do specific house work or chores is part of the ABA treatment plan for the member/identified patient  Provider travel time  Babysitting  Respite for parents/family members  Provider residing in the member’s home and functioning as live-in help (e.g. in an au-pair role)  Peer-mediated groups or interventions  Training or classes for groups of parents of different patients  Hippotherapy/equestrian therapy  Pet therapy  Auditory Integration Therapy  Sensory Integration Therapy  Prescription drugs. These are covered under the Prescription Drugs benefit  Any other activity that is not considered to be a behavioral assessment or intervention utilizing applied behavior analysis techniques  Prescription drugs. These are covered under the Prescription Drugs benefitDrugs.  Treatment of sexual dysfunctions, such as impotence  Institutional care, except that services are covered when provided for an illness or injury treated in an acute care hospital  EEG biofeedback or neurofeedback  Family and marriage counseling or therapy, except when it is medically necessary to treat your mental condition  Therapeutic or group homes, xxxxxx homes, nursing homes boarding homes or schools and child welfare facilities  Outward bound, wilderness, camping or tall ship programs or activities  Mental health tests that are not used to assess a covered mental condition or plan treatment. This plan does not cover tests to decide legal competence or for school or job placement.  Detoxification services that do not consist of active medical management. See Definitions.  Support groups, such as Al-Anon or Alcoholics Anonymous  Services that are not medically necessary. This is true even if a court orders them or you must get them to avoid being tried, sentenced or losing the right to drive.  Sober living homes, such as halfway houses  Residential treatment programs or facilities that are not units of hospitals, or that the state has not licensed or approved for residential treatment  Caffeine dependence