How Benefits Are Provided
The way mental health and substance abuse benefits are provided depends on the medical plan you are enrolled in and the type of care you need.
If you are enrolled in a medical plan administered by Anthem Blue Cross (except for HSA Medical Plan)
Treatment
Benefits Provided by
Inpatient and Alternate Levels of Care for Mental Health
Mental Health and Substance Abuse Benefits Administered by ValueOptions
Outpatient Mental Health
Inpatient and Alternate Levels of Substance Abuse
Outpatient Substance Abuse
Autism Applied Behavior Analysis (ABA)
Fully covered; requires authorization by plan.
Applied Behavioral Analysis (ABA) is a type of treatment for autism that emphasizes behavioral training and management through positive reinforcement, self-help, and social skills training. ABA is used to help improve behavior, communication, and overall function. ABA for the treatment of autism is fully covered under both administrators.
Administered by ValueOptions
If you are enrolled in the HSA Medical Plan
For HSA Medical Plan members, all Mental Health and Substance Abuse benefits are provided by Anthem Blue Cross.
If you are enrolled in either Kaiser Permanente EPO – North or South or Kaiser Permanente Senior Advantage North and South
Treatment
Benefits Provided by
Inpatient Mental Health
Kaiser Permanente EPO or Kaiser Permanente Senior Advantage HMO
Outpatient Mental Health
Medically Necessary Detoxification, Inpatient and Residential Level of Substance Abuse
Administered by ValueOptions
Medically Necessary Detoxification Substance Abuse Outpatient
Kaiser Permanente EPO or Kaiser Permanente Senior Advantage
Structured Outpatient, Partial Hospitalization and Outpatient Substance Abuse
Kaiser Permanente EPO or Kaiser Permanente Senior Advantage HMO
Autism Applied Behavior Analysis (ABA)
Fully covered; requires authorization by plan.
Applied Behavioral Analysis (ABA) is a type of treatment for autism that emphasizes behavioral training and management through positive reinforcement, self-help, and social skills training. ABA is used to help improve behavior, communication, and overall function. ABA for the treatment of autism is fully covered under both administrators.
Administered by ValueOptions or Kaiser Permanente
If you are enrolled in Blue Shield HMO, Health Net HMO, Blue Shield Medicare COB HMO, or Health Net Medicare COB HMO
Treatment
Benefits Provided by
Inpatient Mental Health
Your HMO
Outpatient Mental Health
Medically Necessary Detoxification, Inpatient and Alternate Levels of Substance Abuse
ValueOptions
Outpatient Substance Abuse
Autism Applied Behavior Analysis (ABA)
Fully covered; requires authorization by plan.
Applied Behavioral Analysis (ABA) is a type of treatment for autism that emphasizes behavioral training and management through positive reinforcement, self-help, and social skills training. ABA is used to help improve behavior, communication, and overall function. ABA for the treatment of autism is fully covered under both administrators.
Administered by ValueOptions
If you are enrolled in the Health Net Seniority Plus
Treatment
Benefits Provided by
Inpatient Mental Health
Health Net Seniority Plus
Outpatient Mental Health
Medically Necessary Detoxification, Inpatient and Alternate Levels of Substance Abuse
ValueOptions or separately by Health Net Seniority Plus
Outpatient Substance Abuse
Autism Applied Behavior Analysis (ABA)
Fully covered; requires authorization by plan.
Applied Behavioral Analysis (ABA) is a type of treatment for autism that emphasizes behavioral training and management through positive reinforcement, self-help, and social skills training. ABA is used to help improve behavior, communication, and overall function. ABA for the treatment of autism is fully covered under both administrators.
Administered by ValueOptions
For All Plans
Because the benefits and the delivery method differ depending on the medical plan in which members are enrolled, the information on Deductibles and Limits, Coinsurance and Copayments, How the Program Works, and What the Program Covers are specific to each plan or type of plan.
The subsections entitled "Medically Necessary," "What the Program Does Not Cover," "More About the Program," and "Claims and Appeals Process" apply to members of all medical plans.
Questions?
Do you have general questions concerning mental health and substance abuse treatment? Contact ValueOptions at 800-562-3588.