PacifiCare HMO Plan Participants

Getting Started: Mental Health & Chemical Dependency Treatment

Important:
The Board of Trustees has implemented a Member Assistance Program, called MAP for short. The purpose of the Member Assistance Program is to provide you and your spouse with a professional consultation and referral program for personal, mental health, and chemical dependency problems. For example, typical reasons for which the MAP is accessed are problems with drug and alcohol abuse, eating disorders, marriage and family issues, work issues, parenting and childcare issues.

This Program provides benefits only for the specific Mental Health & Chemical Dependency benefits as described in this Summary Plan Description. The Program requires that all benefits be pre-authorized by PacifiCare Behavioral Health.

This is a Managed Care Program, and PBH will refer you, when appropriate, to a PBH provider or facility that is under contract with PBH, called an In-Network Provider or Facility.  For example, there are no benefits provided for any inpatient mental health or chemical dependency benefits unless the treatment plan is authorized in advance by PBH, and the authorized treatment is provided by an In-Network PBH contracted facility.

By having your care managed by PBH, you will be assured of receiving the treatment best suited to your particular problem.  In addition, managed care means that the length and quality of treatment is monitored in order to curb any claim abuses.