FY2011 Health Benefits Booklet

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34 s u m m a r y o f g e n e r a l b e n e f i t s j u l y 2 0 1 0 – j u n e 2 0 1 1 Mental Health/Substance Abuse Benefits Your Choices If you enroll in a State medical plan, you and your enrolled dependents will automatically receive mental health and substance abuse coverage. However, the network of providers for these benefits varies depending on the medical plan in which you are enrolled. If you are enrolled in... EPO plan PPO or POS plan How the Plans Work Your mental health and substance abuse benefits are managed by... The EPO plan network APS Healthcare network (APS) EPO PlanS Your EPO plan must authorize all of your inpatient mental health and substance abuse services to be eligible for coverage. In addition, out-of-network services are not covered under any of the EPO plans. Below is a brief look at the coverage provided by the EPO plans. Please see chart on page 35 for details. You must be enrolled in a State medical plan to have mental health and substance abuse benefits. PPO and Pos Plans Your mental health and substance abuse benefits are provided by APS Healthcare Bethesda, Inc. The following types of services are covered under this plan: a• Inpatient facility and professional services; a• Partial hospitalization; a• Intensive Outpatient Program; and a• Outpatient facility and professional services. To get the most from your benefits, you should contact APS before receiving any services. For a participating list of providers, contact APS at 1-877-239-1458 or visit www. APSHelpLink.com. Notes about Your Mental Health and Substance Abuse Coverage a• Inpatient Care – There is no limit to medically necessary and treatable preauthorized inpatient days. a• Outpatient Care – There is no limit on the number of medically necessary/treatable visits per year. Eligible mental health and substance abuse services are covered at the same level. Substance abuse detoxification and rehabilitation services are covered under inpatient, partial hospitalization, or outpatient services when medically necessary. See the benefit chart on page 35 for how the plan will pay benefits. If you experience a non-life threatening emergency or crisis, contact the APS Help Line at 1-877-239-1458 for immediate assistance. If you experience a lifethreatening emergency, you should seek treatment at the nearest emergency room. You must notify APS within 24 hours of an emergency admission to certify care. APS team members are available 24 hours a day, seven days a week, 365 days a year.
Maryland State Employees and Retirees 35 Mental Health and Substance Abuse Coverage for PPO and Pos Plan Participants type OF SERvICE in-NETWORk CARE out-OF-NETWORk CARE Inpatient Facility and Professional Services Partial Hospitalization Services and Residential Crisis Services 100% of APS’ negotiated fee maximums when preauthorized by Plan 80% of APS’ negotiated fee maximums 100% of APS’ negotiated fee maximums 80% of APS’ negotiated fee maximums Outpatient Facility 100% of APS’ negotiated fee maximums 80% of APS’ negotiated fee maximums Office and Professional Services (excluding Intensive Outpatient Services) $15 copay for PCP/Specialist 80% of APS’ negotiated fee maximums Intensive Outpatient Services $15 copay for PCP/Specialist 80% of APS’ negotiated fee maximums Outpatient Medication Management Services $15 copay for PCP/Specialist 80% of APS’ negotiated fee maximums Emergency Room Services In-network and Out-of-Network (Paid by medical plan, not APS) Annual Deductible Individual Family Annual Out of Pocket Maximum Individual Family (Combined with Medical) Not Applicable None None 100% of medical plan allowed benefit after $50 copay for ER Facility Care and $50 copay for ER Physician Services Not Applicable $3,000 $6,000 Lifetime Maximum (Combined with Medical) $2,000,000 per person Mental Health and Substance Abuse Coverage for EPO Plan Participants type OF SERvICE in-NETWORk CARE out-OF-NETWORk CARE Inpatient Facility and Professional Services Partial Hospitalization Services and Residential Crisis Services 100% of the allowed benefit when preauthorized by Plan Not Covered 100% of the allowed benefit Not Covered Outpatient Facility 100% of the allowed benefit Not Covered Office and Professional Services (excluding Intensive Outpatient Services) Intensive Outpatient Services Outpatient Medication Management Services Emergency Room Services In-network and Out-of-Network (Paid by medical plan, not APS) Annual Deductible Individual Family Annual Out of Pocket Maximum Individual Family Lifetime Maximum Balance up to the allowed benefit after member co-pay. $15 copay for PCP/Specialist Balance up to the allowed benefit after member co-pay. $15 copay for PCP/Specialist Balance up to the allowed benefit after member co-pay. $15 copay for PCP/Specialist Not Applicable Not Applicable Not Covered Not Covered Not Covered 100% of allowed benefit after $50 copay for ER Facility Care and $50 copay for ER Physician Services Unlimited Not Applicable Not Applicable MENTAL HEALTH BENEFITS NOTE: The benefits described above are in compliance with the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008.
Page 1 and 2: State of Maryland July 2010 - June
Page 3 and 4: Table of Contents Introduction.....
Page 5 and 6: Maryland State Employees and Retire
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FY2011 Health Benefits Booklet

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