Benefits for Mental or Nervous Disorders

IMPORTANT REMINDER - Benefits are payable for treatment of mental or nervous disorders ONLY IF the treatment has been precertified by ValueOptions. This requirement also applies to initial evaluations and psychological testing.

Benefits for treatment of mental or nervous disorders are payable for three types of treatment: full-time inpatient confinement, partial inpatient care (day care), and outpatient treatment.

  1. Full-Time Inpatient Confinement - Up to 45 days per year (or up to 45 days for any one continuous confinement) for covered full-time inpatient hospital treatment.
    • If the confinement is in an in-network hospital, the Plan will pay 80% of the covered expenses incurred (no deductible applies).
    • For an out-of-network confinement, the Plan will pay 80% of the covered expenses incurred in excess of the $250 calendar year deductible. (The deductible will apply only once to any continuous inpatient confinement, even if the confinement begins during one year and continues without interruption into the following year. There is a $500 deductible limit per family per calendar year.)
  2. Partial Inpatient Care (Day Care) - This treatment method provides treatment to a person in a hospital or approved facility during the day, but allows the person to go home at night.
    • For in-network and out-of-network treatment, the Plan will pay 80% (no deductible applies) of the covered expenses incurred for up to 75 days of treatment per year.
  3. Outpatient Treatment
    • For in-network outpatient treatment, the Plan will pay 90% of the covered expenses incurred (no deductible applies).
    • For out-of-network outpatient treatment, the Plan will pay 80% (no deductible applies) of the covered expenses incurred for the first 8 sessions and 50% thereafter. Benefits are payable for out-of-network outpatient treatment only if the provider is an M.D., D.O. or licensed clinical psychologist.

NOTE - If the Lineco Member Assistance Program (MAP) refers you to a MAP counselor for in-office counseling, your first 6 visits will cost you nothing, regardless of the nature of the counseling. MAP counseling services are separate from the benefits provided under the Mental Health and Substance Abuse Benefit. After your 6 MAP visits, further care must be precertified by ValueOptions.