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Behavioral Health and Substance Abuse
ComPsych Guidance Resources® (ComPsych) is the Plan’s network provider selected to help you obtain the care you need for behavioral health issues, substance abuse and other serious life problems.
You or a family member MUST call ComPsych at 1-888-860-1566 for an authorization BEFORE seeking treatment for behavioral health or substance abuse even if you chose a provider that is not in the ComPsych network. Keep in mind, the ComPsych network is different from your medical provider network which is BCBSIL. The schedule of benefits for behavioral health and substance abuse is separate and distinct from medical benefits.
Take advantage of the Member Assistant Program: You now have access to a Member Assistance Program (MAP) through ComPsych Guidance Resources® (ComPsych) that provides confidential support, resources and information to get through life’s challenges. MAP services are confidential, free of charge to you and available 24 hours a day, 7 days a week. Just call ComPsych at 1-888-860-1566 to speak to a ComPsych counselor about personal problems, such as job pressures, marital and family conflicts, problems with your children, relationship issues, grief and loss, stress, anxiety or depression, empty-nesting, eating disorders, major life changes, physical or emotional abuse, career transition, drug and alcohol abuse, legal issues, financial issues or planning, or simply managing daily life that can affect your work, health and family.
The MAP offers free short-term counseling of up to five sessions (not subject to the Plan’s deductible or co-insurance) with a ComPsych counselor. If a counselor determines that an issue cannot be addressed in the five, free counseling sessions or if a more intensive level of care is required, the counselor will work with you to locate a provider in the ComPsych network – provided the care is covered under the Plan’s behavioral health and substance abuse provisions.
If you find yourself without eligibility for benefits after January 1, 2010, you will still have access to the Members Assistant Program for up to one year.
When you use a ComPsych hospital/provider you will receive a significantly higher level of benefits. This means a lot less money out of your pocket. The Plan pays as follows:
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BEHAVIORAL HEALTH & SUBSTANCE ABUSE BENEFITS
Contracted Provider: ComPsych, Guidance Resources
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ComPsych
In-Network
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Out of Network
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Co-Insurance
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80% paid by Plan
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60% paid by Plan
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Calendar Year Deductible for hospital and professional fees.
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$300/Individual
$900/Family
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$600/Individual
$1,800/Family
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Out-of-Pocket Maximums per Calendar Year
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$2,000/Individual
$6,000/Family
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$6,000/Individual
$18,000/Family
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Penalty for failure to Pre-certify
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$500 per admission
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· Ambulance Services
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80% paid by Plan
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· Emergency Room
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80% paid by Plan
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· Emergency Room Co-Payment
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$250 per Emergency Room Visit.
Waived if Immediately Admitted to the Hospital
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· Hospital Co-Insurance for In-Patient and Partial Hospitalization
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80% paid by Plan
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60% Paid by Plan
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· Hospital Confinement Maximum
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180 days per Calendar Year for In-Patient and Partial Hospitalization combined
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· Hospital Out Patient Diagnostic Tests
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80% paid by Plan
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60% paid by Plan
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· Intensive Outpatient and Outpatient Treatments
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80% paid by Plan
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60% paid by Plan
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Subject to PPO Calendar Year Deductible and PPO Out of Pocket Maximum
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Subject to Non-PPO Calendar Year Deductible and Non-PPO Out of Pocket Maximum
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· Residential, Custodial or Group Homes
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No Coverage
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Coverage for Residential Care of Individuals Who Have Suffered from a Traumatic Brain Injury: If you or an eligible dependent has suffered a traumatic brain injury and needs behavioral health or substance abuse treatment, the Plan provides for residential, custodial or group home treatment. You or a family member must call ComPsych and a ComPsych provider must be used.
All hospital and professional benefits are subject to the calendar year deductibles and out–of-pocket maximums. PPO in-network and non-PPO out-of-network deductibles and out-of-pockets maximums are separate and cannot be combined. The Plan does not pay for expenses above reasonable and customary charges for non-PPO out-of-network providers. Please see your Summary Plan Description, or visit our website at www.cdccbenefits.org for more information.
Pre-Certification/Authorization – A ComPsych Care Manager will help you identify your options and develop a treatment plan that may include counseling, referrals to community resources or more intensive clinical treatment. The Care Manager will help you select a provider from the ComPsych network that specializes in your problem and that is in a location convenient to you. Although you do not have to use a ComPsych network provider, benefits will be paid at a higher level if one is used. All claims for mental health and substance abuse benefits must be filed with ComPsych at: P.O. Box 8379, Chicago, IL 60680-8379.
Concurrent Review - During your treatment, a ComPsych Care Manager will work with your provider and monitor the progress to make sure that the care received is appropriate and effective. Benefits will be paid only if your treatment is determined medically necessary by ComPsych.
Remember, to receive the highest level of benefits you or a family member must have all care authorized by ComPsych at 1-888-860-1566 and use a provider in the ComPsych network.
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