NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • Non-network Mental Health inpatient and outpatient treatment services shall be subject to the same but separate non-network hospital component benefits and the same but separate non-participating provider basic medical benefits including deductible, co-insurance and reimbursement schedule. Ex- penses applied against the deductible and co-insurance levels indicated above will not apply against any deductible or co-insurance levels maximums under the Basic Medical portion of the Plan. Effective Sep- tember 1, 2013, covered expenses for non-network mental health and substance abuse treatment will be included in the combined deductible and combined co-insurance maximum as set forth in Article 39.6 (c) and (d) of the Agreement.
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • Non-network coverage for mental health and substance use treatment is subject to the same deductibles and coinsurance maximums as the non-network Hospital and Basic Medical coverages. • Covered expenses for non-network mental health and substance use treatment will be in- cluded in the combined deductible and combined coinsurance maximum as set forth in section 9.3(a) and (b) of this Article. * Effective January 1, 2024 when non-participating providers are used, benefits will be paid at the rate of 275 percent of the Medicare Physician Fee Schedule in effect on the date of service. Benefits will continue to be subject to deductible, coinsurance, and calendar year maximums.
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • Non-network coverage for mental health treatment is subject to the same deductibles and coinsurance maximums as the nonnetwork Hospital and Basic Medical Program coverages; • No out-of-pocket maximum; • Medically necessary inpatient alcohol and substance abuse treatment will be limited to one stay per year and three stays per lifetime. There will be a maximum of 30 outpatient visits approved per calendar year. Expenses applied against the deductible and copay levels indicated above will not apply against any deductible or copay levels or maximums under the basic medical portion of the Plan.
NON-NETWORK BENEFIT. Medically necessary care rendered outside of the network will be subject to the following provisions: • 30 inpatient days and 30 outpatient visits maximum per year for mental health treatment; • Inpatient and outpatient reimbursement will be no greater than 50 percent of the in- network discounted fees; • Inpatient deductible will be $2,000 per year and the outpatient deductible will be $500 per year; no out-of-pocket maximum; • The maximum lifetime benefit for non-network substance abuse services shall be $100,000. Effective January 1, 2007, the maximum lifetime benefit for non-network substance abuse services shall be increased to $250,000. • Medically necessary inpatient alcohol and substance abuse treatment will be limited to one stay per year and three stays per lifetime. There will be a maximum of 30 outpatient visits approved per calendar year. • Expenses applied against the deductible and coinsurance levels indicated above will not apply against any deductible or coinsurance maximums under the basic medical portion of the Plan.
NON-NETWORK BENEFIT. Mental Health Treatment: • Medically necessary non-network coverage for mental health treatment is subject to the same deductible and coinsurance maximums as the non-network Hospital and Medical benefits. - Substance Abuse Treatment • Effective January 1, 2010 the maximum lifetime benefit for non-network substance abuse services will be unlimited. • Medically necessary inpatient alcohol and substance abuse treatment will be unlimited. • Effective January 1, 2010 the maximum of 30 outpatient visits approved per calendar year will be eliminated. • Effective January 1, 2010 medically necessary non-network coverage for mental health treatment is subject to the same deductible and coinsurance maximums as the non-network Hospital and Medical benefits. • Expenses applied against the deductible and coinsurance levels indicated above will not apply against any deductible or coinsurance maximums under the basic medical portion of the Plan.
