Mental Health and Substance Abuse Coverage
EAP Coverage Is Separate
In addition to the mental health and substance abuse you have through your Health Account Plan (HAP), you also have access to counseling and other mental health resources through the Employee Assistance Program (EAP). The EAP is available even if you decline medical coverage. For details, see the Employee Assistance Program (EAP) section.
The Company provides mental health and substance abuse treatment for you and your Eligible Dependents.
The way you receive mental health and substance abuse benefits ("behavioral health coverage") depends on which Health Account Plan (HAP) claims administrator you have selected. You and your Eligible Dependents are automatically enrolled in the appropriate program when you enroll in the HAP. ValueOptions, a behavioral health managed care company, is the primary administrator of your mental health and substance abuse coverage if you are in the Anthem HAP. If you are in the KPIC HAP, KPIC will be your primary administrator of your mental health and substance abuse coverage (see "What the HAP Covers" for additional information).
To differentiate behavioral health treatment from medical treatment, the following is needed:
  • The diagnosis must be in the DSM 5 (Diagnostic and Statistical Manual, Fifth Edition)
  • Services must be provided by an independently licensed mental health provider using services codes specific to psychotherapy and psychiatry. For example:
    • If someone receives treatment for depression from his or her PCP or general practitioner, it is not covered by ValueOptions because the provider is not a mental health provider.
    • If someone receives educational testing by a psychologist, it is not covered because educational testing is not covered under the Plan.
    • If someone receives treatment by a psychologist for pain related to a medical condition, i.e., the diagnosis is not in the DSM 5, it is not covered under the Plan.
    • If someone is treated for a drug-overdose due to a suicide attempt, the medical services (stomach pump, injections, and medical observation) are covered under the medical provisions of the HAP; however, a psychiatric evaluation performed by a psychiatrist to evaluate the potential danger to the person being treated would be covered by the mental health and substance abuse provisions.
There are no lifetime benefit limits, and no pre-existing exclusions.