Coinsurance and Copayments for NAP Members
The following chart summarizes your mental health benefits if you are enrolled in NAP. All benefits are based on Eligible Expenses. See "Eligible Expenses" under "What the Program Covers for NAP Members."
Usual and Customary Fees
A "usual" fee is the fee that an individual provider most frequently charges for a specific procedure — the "usual" fee charged in a geographic area by a medical provider for a specific medical procedure or service. The fee is based upon a consensus of what most other providers are charging for a similar procedure or service. A "customary" fee is the fee level determined by the claims administrator from actual fees submitted for a specific procedure. This fee establishes the maximum benefit payable for that procedure.
Provision
Combined Mental Health and Substance Abuse Benefits
ValueOptions-Administered Network Benefits
ValueOptions-Administered Non-Network Benefits
(Care received from ValueOptions network providers)
(Care received from any licensed provider)
Outpatient Treatment
  • No charge for initial visit to psychiatrist for medication evaluation.
  • $10 copay per visit (individual) after deductible
  • $5 copay per visit (group) after deductible
  • No visit limit
  • 70% of "usual and customary" fees after deductible
  • No visit limit
Inpatient Hospitalization and Alternate levels of care
(Partial Hospitalization, Residential Treatment and Structured or Intensive Outpatient Care)
  • 100%
  • after deductible
  • $300 penalty if authorization is not obtained*
  • No limit on the number of stays or treatment programs
  • 70% of "usual and customary" fees after deductible;
  • $300 penalty if authorization is not obtained*
  • No limit on the number of stays or treatment programs
Autism Applied Behavior Analysis (ABA)
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.
Fully Covered
  • Requires authorization by plan
* Inpatient care and Alternate Levels of Care (medically necessary detoxification, partial hospitalization, residential treatment, and intensive or structured outpatient care) must be authorized within 48 hours of the beginning of confinement or treatment in order to avoid a $300 penalty for failure to obtain authorization.