Coinsurance and Copayments for HMO and Kaiser EPO Members
The following chart summarizes your substance abuse care benefits if you are enrolled in an HMO or the Kaiser EPO. (Note the outpatient substance abuse care exception for Kaiser Permanente EPO and Kaiser Permanente Senior Advantage members). All benefits are based on Eligible Expenses. See "Eligible Expenses" under "What the Program Covers for HMO and Kaiser EPO Members." For HMO members, all mental health benefits are provided through the respective plan.
Provision
Substance Abuse Care Benefits
(ValueOptions-Administered Benefits, Care coordinated through ValueOptions)
Outpatient Substance Abuse Care
Requires authorization by ValueOptions
  • $10 copay per visit (individual) after deductible
  • $5 copay per visit (group)after deductible
  • No visit limit
Inpatient Substance Abuse Care and Alternate levels of Care
(Medically necessary detoxification, Partial hospitalization, Residential Treatment, and Intensive or Structured Outpatient Care)
  • 100% after medical plan deductible (if any)
  • Requires authorization by ValueOptions
  • No limit on the number of stays
Please note that ValueOptions (VO) is the Claims Administrator only for the benefits that are included under the Substance Abuse Program — not the benefits that are provided by the various HMOs.
For details on the benefits provided by each HMO, refer to your HMO's evidence of coverage (EOC) or call your HMO's member services number. For details on the benefits provided by the Kaiser EOP plan, refer to your Kaiser SPD.