Mental Health and Substance Abuse Coverage
The Company provides mental health and substance abuse benefits for you and your Eligible Dependents.
The way you receive mental health and substance abuse benefits ("behavioral health coverage") depends on which medical plan you're enrolled in. You and your Eligible Dependents are automatically enrolled in the appropriate program when you enroll in a medical plan. ValueOptions, a behavioral health managed care company, is the primary administrator of the mental health and substance abuse programs for many of the medical plans (see "How Benefits Are Provided" for additional information).
To differentiate the ValueOptions behavioral health coverage from the medical coverage, the following is needed:
  • The diagnosis must be in the DSM V (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 their PCP or general practitioner, it is not covered by the ValueOptions plan 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 V, 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 not covered; however, a psychiatric evaluation performed by a psychiatrist to evaluate the potential danger to the person being treated would be covered.
Note that the general provisions for Mental Health and Substance Abuse benefits are separate from the medical plan provisions. There are no lifetime benefit limits, and no pre-existing exclusions.