Serious Mental Illness. Covered Services include treatment of Serious Mental Illness when authorized by HMO or its designated behavioral health administrator and rendered by a Participating Provider which includes a Psychiatric Day Treatment Facility. Services are subject to the same terms and conditions as medical and surgical benefits for any other physical illness. Chemical Dependency Services. Coverage for treatment of Chemical Dependency is the same as coverage for treatment of any other physical illness, but is restricted as described in LIMITATIONS AND EXCLUSIONS. Inpatient treatment of Chemical Dependency must be provided in a Chemical Dependency Treatment Center. Some services may require Preauthorization by HMO or its designated behavioral health administrator. Emergency Services PCPs provide coverage for Members 24 hours a day, 365 days a year. You must notify Your PCP within forty- eight (48) hours of receiving Emergency Care, or as soon as possible without being medically harmful or injurious to You. HMO will pay for a medical screening examination or other evaluation required by Texas or federal law and provided in the emergency department of a Hospital emergency facility, freestanding emergency medical care facility, or comparable emergency facility that is necessary to determine whether an emergency medical condition exists.
Serious Mental Illness. Covered Services include treatment of Serious Mental Illness when authorized by HMO or its designated behavioral health administrator and rendered by a Participating Provider which includes a Psychiatric Day Treatment Facility. Services are subject to the same terms and conditions as medical and surgical benefits for any other physical illness. Chemical Dependency Services. Coverage for treatment of Chemical Dependency is the same as coverage for treatment of any other physical illness but is restricted as described in LIMITATIONS AND EXCLUSIONS. Inpatient treatment of Chemical Dependency must be provided in a Chemical Dependency Treatment Center. Some services may require Prior Authorization by HMO or its designated behavioral health administrator. Emergency Services PCPs provide coverage for Members 24 hours a day, 365 days a year. You must notify Your PCP within forty-eight
Serious Mental Illness. (“SMI”) is a mental, behavioral, or emotional disorder of mood, thought, or anxiety that significantly impairs: judgment, behavior, capacity to recognize reality, or ability to cope with the ordinary demands of life. Those disorders include, but are not limited to, Schizophrenia Spectrum Disorders, other Psychotic Disorders, Bipolar Related Disorders, and Major Depressive Disorders. III. SUBSTANTIVE PROVISIONS POLICIES AND PROCEDURES
Serious Mental Illness refers to emotional or behavioral functioning so impaired as to interfere with the individual’s capacity to remain in the community without supportive treatment.
Serious Mental Illness. (“SMI”) is a major mental disorder as described in 42 CFR 483 Subpart C (i)-(iii). Application of this definition should also take into consideration the current Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions such as Schizophrenia Spectrum Disorders, other Psychotic Disorders, Bipolar Related Disorders, Depressive Disorders, Anxiety Disorders, Personality Disorders, Trauma Related Disorders or other major mental disorders that result in functional limitations in major life activities, including within the 6 months prior to nursing facility application, are not a primary diagnosis of dementia or co-occurring with a primary diagnosis of dementia, and are not episodic or situational.
Serious Mental Illness. As defined in MCL 330.1100(d)(4) of the Mental Health Code.
Serious Mental Illness. In Network visits: 60 days/calendar year, combined in/out of network; $20 copay; Out of Network visits: 60 days/calendar year, combined in/out of network; 80% of charges after deductible up to $80 max per visit. INPATIENT 30 days/calendar year combination in/out of network Mental Health In Network: 100% 6 As and to the extent required by law, the Board shall retain all Employees age 65 and over in the coverage described in XIII.A.(1) through (4) as their primary coverage (Medicare Parts Out of Network: 80% after deductible up to 30 days/calendar year Serious Mental Illness In Network: 100% Out of Network: 80% after deductible The Pap Smear Rider and Psychological Out-of-State Rider shall be included as part of the coverage, as provided by the carrier; provided, however, that to be entitled to psychological benefits, the psychologist must be duly licensed in Pennsylvania or in the jurisdiction in which s/he practices and performs services, in accordance with the requirements of the carrier. Consistent with Independence Blue Cross requirements, maternity coverage shall include all females, including dependent children.
