Coinsurance and Copayments for CAP Members
All benefits are based on Eligible Expenses. See "Eligible Expenses" under "What the Program Covers for CAP Members."
Provision
Mental Health and Substance Abuse Benefits
(ValueOptions-Administered Benefits)
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
Inpatient Hospitalization and Alternate Levels of Care
(Partial Hospitalization, Residential Treatment, and Intensive or Structured Outpatient Services)
  • $100% after deductible
  • $300 penalty if authorization is not obtained*
  • No limit on the number of stays
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.