What the Program Covers for CAP Members
Eligible Expenses
All benefits are based on "Eligible Expenses," which are:
  • expenses for Covered Health Services that are covered by the plan,
  • those expenses that ValueOptions considers "Medically Necessary" for diagnosis or treatment; and
  • those that do not exceed the "Usual and Customary" rate, as determined by ValueOptions.
Any costs not meeting this definition are the responsibility of the member. For additional information or questions, call ValueOptions.
Benefits
Mental health and chemical dependency expenses covered under the Program include:
  • Outpatient treatment;
  • Alternate Levels of Care
    • Partial hospitalization,
    • Residential treatment programs,
    • Intensive and structured outpatient care;
  • Inpatient hospitalization; and
  • Detoxification, medically necessary (medical detoxification may be covered under your Company-sponsored medical plan).
You receive benefits only if:
  • your treatment plan is medically necessary (see "Medically Necessary"); and
  • the primary diagnosis is a mental health condition, alcoholism, or drug dependency as found within the Diagnostic and Statistical Manual of Mental Disorders (DSM V).
Mental Health
Inpatient
For mental health benefits, after the annual deductible has been satisfied, the Program pays 100% of the cost of inpatient hospitalization. A $300 penalty applies if you fail to obtain authorization within 48 hours of the beginning of confinement. There is no maximum on the number of stays.
Alternate Levels of Care
For mental health Alternate Levels of Care, after the annual deductible has been satisfied, the Program pays 100% of the cost of partial hospitalization programs, residential treatment programs, intensive outpatient services and structured outpatient services. If treatment is not authorized within 48 hours of the beginning of confinement or treatment, a $300 penalty will apply. There is no maximum on the number of stays, programs, or services.
Outpatient
After the annual deductible has been satisfied, you pay $10 a visit for outpatient individual therapy or $5 a visit for group therapy. There is no copayment for an initial visit to a psychiatrist for medication evaluation. There is no maximum on the number of visits.
Substance Abuse
Inpatient
For inpatient substance abuse treatment, after the annual deductible has been satisfied, the Program pays 100% for treatment. A $300 penalty applies if you fail to obtain authorization within 48 hours of the beginning of confinement. There is no limit on the number of stays.
Alternate Levels of Care
For substance abuse treatment Alternate Levels of Care, after the annual deductible has been satisfied, the Program pays 100% of the cost of partial hospitalization programs, residential treatment programs, intensive outpatient services and structured outpatient services. If treatment is not authorized within 48 hours of the beginning of confinement or treatment, a $300 penalty will apply. There is no maximum on the number of stays, programs, or services.
Outpatient
After the annual deductible has been satisfied, you pay $10 a visit for individual therapy or $5 a visit for group therapy. There is no maximum on the number of visits.