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Please note that benefits for mental health/substance abuse care may differ for Members enrolled in the High Deductible Plan Option. For full plan details, please refer to the High Deductible Plan Document.
Preauthorization
To obtain preauthorization for the specified Mental Health/Substance Abuse care, contact Anthem Blue Cross Blue Shield at 1-866-776-4793. If a member fails to obtain preauthorization, WELS VEBA will not reimburse charges for the member's care.
Mental Health Inpatient Services
The Plan will reimburse 80% of Preauthorized Usual, Customary and Most commonly accepted charges (UCM) for up to 30 days per Plan Year. The Member's out-of-pocket expenses for this benefit are limited to $2,000 for each Plan Year.
Mental Health Partial & Intense Outpatient Services
The Plan will reimburse 80% of Preauthorized UCM charges for up to 60 days per Plan Year. Member's out-of-pocket expenses for this benefit are limited to $2,000 for each Plan Year.
Please note that this is a separate out-of-pocket maximum than Inpatient Mental Health.
Substance Abuse Inpatient Services
The Plan will reimburse 80% of Preauthorized UCM charges for up to two inpatient courses of rehabilitative treatment during a member's lifetime. The Member's out-of-pocket expenses for this benefit are limited to $2,000 per Plan Year.
Substance Abuse Partial & Intense Outpatient Services
The Plan will reimburse 80% of Preauthorized UCM charges for up to 60 days per lifetime. The Member's out-of-pocket expenses for this benefit are limited to $2,000 per Plan Year.
Please note that this is a separate out-of-pocket maximum than Inpatient Substance Abuse.
Mental Health/Substance Abuse Outpatient Visits *
The Plan will reimburse 70% of UCM charges for 36 Outpatient Mental Health/Substance Abuse visits per Plan Year. Outpatient care includes counseling, drug management, family therapy and psychological testing.
36 visits is a combined benefit for Mental Health and Substance Abuse visits per Plan Year.
* PREAUTHORIZATION IS NOT REQUIRED FOR THIS BENEFIT.
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