Mental Health Care and Substance Sample Clauses

Mental Health Care and Substance. Related and Addictive Disorders Services Mental Health Care and Substance-Related and Addictive Disorders Services include those received on an inpatient or outpatient basis in a Hospital, an Alternate Facility or in a provider's office, at a mental health clinic licensed by the Massachusetts Department of Public Health, at a public community mental health center or as a home-based service, to treat: • Biologically-based mental disorders. For the purposes of this Benefit, "biologically-based mental disorders" includes schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder, delirium and dementia, affective disorders, eating disorders, post-traumatic stress disorder, and Substance Use Disorder Treatment, including alcoholism." Benefits related to Autism Spectrum Disorders are provided under Autism Spectrum Disorder Services below. • Rape-related mental or emotional disorders for victims of rape or assault with intent to commit rape. • Non-biologically-based Mental Illness of Dependent children under 19 years of age when the Primary Care Provider, pediatrician, or licensed mental health professional treating the child has documented that the Mental Illness substantially interferes with or substantially limits the functioning and social interactions of the child or is evidenced by conduct including, but not limited to:  An inability to attend school as a result of the disorder.  The need to hospitalize the child as a result of the disorder. Sample  A pattern of conduct or behavior caused by the disorder which poses a serious danger to the child or others.  Benefits for Mental Health Care Services that would otherwise terminate due to a Dependent child having reached 19 years of age may be continued for an Enrolled Dependent child who is engaged in an ongoing course of treatment beyond age 19 until that course of treatment is completed. • Any other Mental Illness or mental health disorder not described above. All services must be provided by or under the direction of a properly qualified behavioral health provider. Benefits include the following levels of care: • Inpatient treatment. • Residential Treatment. • Partial Hospitalization/Day Treatment. • Intensive Outpatient Treatment. • Outpatient treatment. Inpatient treatment and Residential Treatment includes room and board in a Semi-private Room (a room with two or more beds). Services inclu...
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Mental Health Care and Substance. Related and Addictive Disorders In addition to all other exclusions listed in this Section 2: Exclusions and Limitations, the exclusions listed directly below apply to services described under Mental Health Care and Substance-Related and Addictive Disorders Services in Section 1: Covered Health Care Services.
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Mental Health Care and Substance. Related and Addictive Disorders Services Inpatient 40% Yes Yes Outpatient 40% for Partial Hospitalization/ Intensive Outpatient Treatment/Intensive Behavioral Therapy Office Visit 40% Yes Yes Yes Yes
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Mental Health Care and Substance. Related and Addictive Disorders
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Mental Health Care and Substance. Related and Addictive Disorders Services Mental Health Care and Substance-Related and Addictive Disorders Services include those received on an inpatient or outpatient basis in a Hospital, an Alternate Facility or in a provider's office. All services must be provided a behavioral health provider who is properly licensed and qualified by law, and acting within the scope of their licensure. SAMPLE Benefits include the following levels of care: • Inpatient treatment. • Residential Treatment. • Partial Hospitalization/Day Treatment. • Intensive Outpatient Treatment. • Outpatient treatment. Inpatient treatment and Residential Treatment includes room and board in a Semi-private Room (a room with two or more beds). Services include the following: • Diagnostic evaluations, assessment and treatment, and/or procedures. • Medication management. • Individual, family, and group therapy. • Crisis intervention. • Detoxification on either an inpatient or outpatient basis, if Medically Necessary. The Mental Health/Substance-Related and Addictive Disorders Designee provides administrative services for all levels of care. We encourage you to contact the Mental Health/Substance-Related and Addictive Disorders Designee for referrals to providers and coordination of care.
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Mental Health Care and Substance. Related and Addictive Disorders Services Mental Health Care and Substance-Related and Addictive Disorders Services include those received on an inpatient or outpatient basis in a Hospital, an Alternate Facility or in a provider's office. All services must be provided by a behavioral health provider who is properly licensed and qualified by law, and acting within the scope of their licensure. Benefits include the following levels of care: • Inpatient treatment. • Residential Treatment. • Partial Hospitalization/Day Treatment. • Intensive Outpatient Treatment. • Outpatient treatment. • Voluntary and court-ordered residential substance abuse. Inpatient treatment and Residential Treatment includes room and board in a Semi-private Room (a room with two or more beds). Services include the following: • Diagnostic evaluations, assessment and treatment, and/or procedures. • Medication management. • Individual, family, and group therapy. • Crisis intervention. • Electroconvulsive therapy (ECT). • Inpatient and outpatient detoxification, including medical detoxification. • Biofeedback for pain management. • Mental Health Care Services for Autism Spectrum Disorder (including Intensive Behavioral Therapies such as Applied Behavior Analysis (ABA)) that are the following: ▪ Focused on the treatment of core deficits of Autism Spectrum Disorder. ▪ Provided by a Board Certified Behavior Analyst (BCBA) or other qualified provider under the appropriate supervision. ▪ Focused on treating maladaptive/stereotypic behaviors that are posing danger to self, others and property, and impairment in daily functioning. SAMPLE This section describes only the behavioral component of treatment for Autism Spectrum Disorder. Medical treatment of Autism Spectrum Disorder is a Covered Health Care Service for which Benefits are available under the Habilitative Services and Rehabilitation Services – Outpatient Therapy categories in this Policy. Short-term rehabilitation therapy included in an outpatient facility of physician’s office that is part of a rehabilitation program for the treatment of Autism Spectrum Disorder include physical, speech, and occupational therapy, and are subject to the visit benefit limitations described within the Schedule of Benefits.. The Mental Health/Substance-Related and Addictive Disorders Designee provides administrative services for all levels of care. We encourage you to contact the Mental Health/Substance-Related and Addictive Disorders Designee for referrals t...
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Related to Mental Health Care and Substance

  • Behavioral Health Services – Mental Health and Substance Use Disorder Inpatient - Unlimited days at a general hospital or a specialty hospital including detoxification or residential/rehabilitation per plan year. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Outpatient or intermediate careservices* - See Covered Healthcare Services: Behavioral Health Section for details about partial hospital program, intensive outpatient program, adult intensive services, and child and family intensive treatment. Preauthorization may be required for services received from a non-network provider. 0% - After deductible 40% - After deductible Office visits - See Office Visits section below for Behavioral Health services provided by a PCP or specialist. Psychological Testing 0% - After deductible 40% - After deductible Medication-assisted treatment - whenrenderedby a mental health or substance use disorder provider. 0% - After deductible 40% - After deductible Methadone maintenance treatment - one copayment per seven-day period of treatment. 0% - After deductible 40% - After deductible Cardiac Rehabilitation Outpatient - Benefit is limited to 18 weeks or 36 visits (whichever occurs first) per coveredepisode. 0% - After deductible 40% - After deductible Chiropractic Services In a physician's office - limited to 12 visits per plan year. 0% - After deductible 40% - After deductible Dental Services - Accidental Injury (Emergency) Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Dental Services- Outpatient Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Dialysis Services Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Durable Medical Equipment (DME), Medical Supplies, Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchasedat licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider. Early Intervention Services (EIS) Coverage provided for members from birth to 36 months. The provider must be certified as an EIS provider by the Rhode Island Department of Human Services. 0% - After deductible The level of coverage is the same as network provider. Education - Asthma Asthma management 0% - After deductible 40% - After deductible Emergency Room Services Hospital emergency room 0% - After deductible The level of coverage is the same as network provider.

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

  • Health Care Operations Health Care Operations shall have the meaning set out in its definition at 45 C.F.R. § 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received: • as an inpatient; • as an outpatient; • in your home; • in a doctor’s office; or • from a pharmacy. Also coverage differs depending on whether: • the health care provider is a network provider or non-network provider; • deductibles (if any), copayments, or maximum benefit apply; • you have reached your plan year maximum out-of-pocket expense; • there are any exclusions from coverage that apply; or • our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.

  • Family Care and Medical Leave An unpaid Family Care and Medical Leave shall be granted, to the extent of and subject to the restrictions as set forth below, to an employee who has been employed for at least twelve (12) months and who has served for one hundred thirty days (130) workdays during the twelve (12) months immediately preceding the effective date of the leave. For purposes of this section, furlough days and days worked during off-basis time shall count as "workdays". Family Care and Medical Leave absences of twenty (20) consecutive working days or less can be granted by the immediate administrator or designee. Leaves of twenty (20) or more consecutive working days can be granted only by submission of a formal leave application to the Classified Personnel Assignments Branch.

  • Substance Abuse Program The SFMTA General Manager or designee will manage all aspects of the FTA-mandated Substance Abuse Program. He/she shall have appointing and removal authority over all personnel working for the Substance Abuse Program personnel, and shall be responsible for the supervision of the SAP.

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

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