Coverage

-Substance Abuse outpatient treatment is covered at 80% in-network and 70% out of network. Outpatient treatment is covered only if provided by a Doctor of Medicine (MD), psychologist (PhD), licensed clinical social worker  (LCSW), social worker (MSW), professional mental health nurse practitioner (PMHNP), licensed clinical professional counselor (LCPC), or licensed professional counselor (LPC).
-Substance Abuse inpatient treatment (including but not limited to intensive outpatient services or supplies and partial hospitalization) is covered only when received at a Hospital, Substance Abuse Treatment Facility or Residential Treatment Facility. The Plan pays no other facility charges to treat Substance Abuse.

- Inpatient treatment at a Substance Abuse Treatment
Facility or a Residential Treatment Facility is covered at 80% in-network and is not covered out-of-network; inpatient treatment at a Hospital is covered at 80% in-network and 70% out of-network. There is no coverage for  Educational materials or programs, referral services, or school programs.

Inpatient In-Network Residential Treatment Center Facility or Alcohol and Substance
Abuse Rehabilitation covered services are subject to deductible and coinsurance. Inpatient Out-of-Network Residential Treatment Center Facility or Alcohol and Substance Abuse Rehabilitation services are not covered.  Inpatient In-Network and Out-of-Network: Facility and professional covered services are subject to deductible and coinsurance.

Outpatient In-Network: $25 copayment then deductible and 80% coinsurance for outpatient psychotherapy covered services. Outpatient facility and other professional services are subject to deductible and coinsurance. Outpatient Out-of-Network: $25 copayment then deductible and 70% coinsurance for outpatient psychotherapy covered services. Outpatient facility and other professional services are subject to deductible and  coinsurance.

Outpatient psychotherapy covered services include professional office visit services, family, individual and/or group therapy. 

Benefits apply to inpatient or outpatient psychiatric covered services furnished by any of the following: a) licensed general hospital, b) alcoholism or substance abuse treatment facility, c) psychiatric hospital, d) licensed clinical social worker (LCSW), e) licensed clinical professional counselor (LCPC), f) clinical psychologist, g) physician or h) licensed marriage and family therapist (LMFT).

No benefits for marriage counseling/therapy. No benefits for sexual counseling.