For HMO and Kaiser EPO Members
HMO Benefits
For the HMOs: This document, together with the EOC you receive from your HMO when you enroll, any updates to the EOC you receive from your HMO, the Open Enrollment communications material you receive from the Company on an annual basis, and any summaries of material modifications, constitute your summary plan description for your HMO benefits. In case of conflict between any documents and the EOC, the EOC is the binding document between the HMO and its members, and the EOC will govern.
All mental health treatment for HMO or EPO members is provided through the members' plan. ValueOptions (VO) is the Claims Administrator for inpatient and outpatient substance abuse care coverage for HMO members, except for those enrolled in Kaiser Permanente Senior Advantage, who receive outpatient substance abuse care directly through Kaiser Permanente. Kaiser EPO members also receive outpatient substance abuse treatment directly through Kaiser. In addition, members of Health Net Seniority Plus can elect to receive substance abuse benefits either through ValueOptions or their HMO.
In order to receive benefits from the ValueOptions program for any outpatient care, eligible HMO members must receive a referral or authorization from VO.