 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
 |
|
|
 |
|
|
 |
 |
|
|
|
 |
Summary Plan Description (SPD)
SUMMARY PLAN DESCRIPTION - Integrated Member Assistance Program and Managed Mental Health & Chemical Dependency Benefits Program
For PacifiCare and Self-Funded Indemnity Plan Participants
In This Section:
- Introduction
- PacifiCare HMO Plan Participants
- PacifiCare HMO Plan & Indemnity Medical Plan Participants
- Mental Health & Chemical Dependency Benefits Program
- Definition of Mental Disorder and Chemical Dependency
- What is Clinically/Medically Appropriate Treatment?
- How Does the Program Work?
- What Are the Benefits?
- Questions and Answers About the Program
- Submission of Claims
- Exclusions/Limitations Under the Mental Health & Chemical Dependency Benefits Program
- Medical Necessity – Request for Reconsideration of Denial and Appeals Procedures