Overview
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Integrated Member Assistance Program Manages Mental Health/Chemical Dependency Program
This is a managed care program administered by PacifiCare Behavioral Health (PBH) (877-225-2267). Inpatient care is covered only when pre-authorized by PBH and provided through their network. Limited coverage of non-network outpatient services is available, if medically necessary and clinically appropriate.
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Eligibility
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- Member Assistance Program (MAP): covers all eligible participants.
- Mental Health: covers eligible participants and spouse who have opted for the Indemnity Plan or Pacificare (Kaiser participants receive this care through Kaiser).
- Chemical Dependency: covers eligible participants and spouse who have opted for the Indemnity Plan or Pacificare (Kaiser participants receive this care through Kaiser).
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Member Assistance Program (MAP)
877-225-2267
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This a free confidential counseling and referral service to help you assess a variety of personal problems and suggest ways to resolve them. The following types are examples of typical problems:
- stress, depression, anger management, grief, domestic violence
- child and elder-care
- legal, financial and relationship problems
- substance abuse
There are no Non-Network MAP Benefits.
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Covered Services
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- 24/7, free phone access
- up to 3 face-to-face
MAP assessment sessions per calendar year for assessment purposes
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Mental Health - Outpatient
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In Network
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Non Network
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Individual Session
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$10 co-payment
max. 30 sessions per calendar year
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50% co-insurance
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Group Session
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$0 co-payment
max. 60 sessions per calendar year
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50% co-insurance
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Calendar Year Limits
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A combined limit of 30 network and non-network visits per calendar year with 2 group sessions counted as equal to a single individual session. Annual maximum benefit of $1,000 for non-network providers. If $1,000 maximum is reached, no further network or non-network visits are covered.
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Mental Health - Inpatient/Alternate Care
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In Network
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Non Network
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Inpatient Treatment:
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Program pays 100% of contracted Facility charges after participant’s payment of a $200 per calendar year deductible.
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No coverage
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Residential Treatment & Partial Treatment
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2 days of Treatment in these categories are equal to 1 day of Inpatient Treatment.
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No coverage
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Annual Maximum
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Maximum of 20 days of PBH authorized Inpatient Treatment per eligible participant per calendar year for the medically necessary and clinically appropriate treatment of mental health problems by an PBH contracted Network Facility.
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Severe Mental Illness &
Serious Emotional Disturbances of a Child *
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In Network
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Non Network
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Mental Health - Outpatient
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$0 co-payment
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No coverage
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Mental Health - Inpatient
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Covered at 100%
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No coverage
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* "Severe Mental Illness" and "Serious Emotional Disturbances of a Child" are as defined in the California Mental Health Parity Act. Diagnoses include: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depressive Disorder, Panic Disorder, Obsessive Compulsive Disorder, Pervasive Developmental Disorders (Autism), Anorexia, Bulimia, and Serious Emotional Disturbances of Children.
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Chemical Dependency
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In Network
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Non Network
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Maximum per Episode
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$10,500 per Episode
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No coverage
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Lifetime Maximum Episode
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2 Episodes of Treatment, including Detox
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No coverage
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Detox
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Maximum of $2,000 per Episode. Lifetime maximum of 2 Episodes of Detox
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No coverage
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Inpatient Treatment
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maximum of 20 days of Inpatient Treatment, including Detox days per episode, up to $10,500 per episode maximum.
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No coverage
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Residential Treatment & Partial Treatment
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2 days of Treatment in these categories are equal to 1 day towards the Inpatient Treatment maximum.
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No coverage
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Intensive Outpatient Treatment
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3 days of Intensive Outpatient Treatment are equal to 1 day towards the Inpatient Treatment maximum.
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No coverage
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