Common use of Mental Health Service Administrator (MHSA Clause in Contracts

Mental Health Service Administrator (MHSA. The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care. Blue Shield contracts with the MHSA to underwrite and deliver Blue Shield’s Mental Health and Substance Abuse Services through a separate network of MHSA Participating Providers. Mental Health Services — services provided to treat a Mental Health Condition. MHSA Non-Participating Provider — a provider who does not have an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse Services. MHSA Participating Provider — a provider who has an agreement in effect with the MHSA for the provision of Mental Health or Substance Abuse Services. Network Specialty Pharmacy – select Participating Pharmacies contracted by Blue Shield to provide covered Specialty Drugs. These pharmacies offer 24-hour clinical services and provide prompt home delivery of Specialty Drugs. Non-Participating or Non-Preferred (Non- Participating Provider or Non-Preferred Provider) — refers to any provider who has not contracted with Blue Shield to be included in the EPO provider network and to accept Blue Shield’s payment, plus any applicable Member Deductible, Copayment, Coinsurance, or amounts in excess of specified Benefit maximums, as payment in full for Covered Services provided to Members. This definition does not apply to providers of Mental Health and Substance Abuse Services, which is defined separately under the MHSA Non-Participating Provider definition. Non-Preferred Drugs — Drugs determined by Blue Shield’s Pharmacy and Therapeutics Committee as products that do not have a clear advantage over Formulary Drug alternatives. Benefits may be provided for Non- Preferred Drugs and are always subject to the Non- Preferred Copayment or Coinsurance. Non-Routine Outpatient Mental Health and Substance Abuse Services – Outpatient Facility and professional services for the diagnosis and treatment of Mental Health Conditions and Substance Abuse Conditions, including but not limited, to the following:

Mental Health Service Administrator (MHSA. The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care. Blue Shield contracts with the MHSA to underwrite and deliver Blue Shield’s Mental Health and Substance Abuse Services through a separate network of MHSA Participating Providers. Mental Health Services — services provided to treat a Mental Health Condition. MHSA Non-Participating Provider — a provider who does not have an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse ServicesServices to Members of this Plan. MHSA Participating Provider — a provider who has an agreement in effect with the MHSA for the provision of Mental Health or Substance Abuse ServicesServices to Members of this Plan. Network Specialty Pharmacy – select Participating Pharmacies contracted by Blue Shield to provide covered Specialty Drugs. These pharmacies offer 24-hour clinical services and provide prompt home delivery of Specialty Drugs. Non-Participating or Non-Preferred (Non- Participating Provider or Non-Preferred Provider) — refers to any provider who has not contracted with Blue Shield to be included in the EPO provider network and to accept Blue Shield’s payment, plus any applicable Member Deductible, Copayment, Coinsurance, or amounts in excess of specified Benefit maximums, as payment in full for Covered Services provided to MembersMembers of this Plan. This definition does not apply to providers of Mental Health and Substance Abuse Services, which is defined separately under the MHSA Non-Participating Provider definition. Non-Preferred Drugs — Drugs determined by Blue Shield’s Pharmacy and Therapeutics Committee as products that do not have a clear advantage over Formulary Drug alternatives. Benefits may be provided for Non- Preferred Drugs and are always subject to the Non- Preferred Copayment or Coinsurance. Non-Routine Outpatient Mental Health and Substance Abuse Services – Outpatient Facility and professional services for the diagnosis and treatment of Mental Health Conditions and Substance Abuse Conditions, including but not limited, to the following:

Mental Health Service Administrator (MHSA. The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care. Blue Shield contracts with the MHSA to underwrite and deliver Blue Shield’s Mental Health and Substance Abuse Services Use Disorder Ser- vices through a separate network of MHSA Participating Partic- ipating Providers. Mental Health Services — services provided to treat a Mental Health Condition. MHSA Non-Participating Provider — a provider who does not have an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse Use Disorder Services. MHSA Participating Provider — a provider who has an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse Use Disorder Services. Network Specialty Pharmacy – select Participating Pharmacies contracted by Blue Shield to provide covered Specialty Drugs. These pharmacies offer 24-hour clinical services Negotiated Arrangement (Negotiated National Account Arrangement) — An agreement negoti- ated between a Control/Home Licensee and provide prompt home delivery of Specialty Drugsone or more Par/Host Licensees for any National Account that is not delivered through the BlueCard Pro- gram. Non-Participating or (Non-Preferred (Non- Participating Provider or Non-Preferred Provider) — refers to any provider who has not contracted with Blue Shield to be included in the EPO provider network and to accept Blue Shield’s payment, plus any applicable Member Deductible, Copayment, Coinsurance, or amounts in excess of specified Benefit maximums, as payment pay- ment in full for Covered Services provided to Members. This definition does not apply to providers of Mental Men- tal Health and Substance Abuse Use Disorder Services, which is defined separately under the MHSA Non-Non- Participating Provider definition. Non-Preferred Drugs Occupational Therapy — Drugs determined treatment under the di- rection of a Doctor of Medicine and provided by Blue Shielda certified occupational therapist, or other appropri- ately licensed Health Care Provider, utilizing arts, crafts, or specific training in daily living skills, to improve and maintain a patient’s Pharmacy and Therapeutics Committee as products that do not have a clear advantage over Formulary Drug alternativesability to func- tion. Benefits may be provided Office Visits for Non- Preferred Drugs and are always subject to the Non- Preferred Copayment or Coinsurance. Non-Routine Outpatient Mental Health and Substance Abuse Use Disorder Services – professional office visits for the diagnosis and treatment of Mental Health and Substance Use Disorder Conditions, including the individual, family or group setting. Open Enrollment Period — that period of time set forth in the Contract during which eligible Em- ployees and their Dependents may enroll in this coverage, or transfer from another health benefit plan sponsored by the Employer to this coverage. Orthosis (Orthotics) — an orthopedic appliance or apparatus used to support, align, prevent or cor- rect deformities, or to improve the function of movable body parts. Other Outpatient Mental Health and Substance Use Disorder Services – Outpatient Facility and professional services for the diagnosis and treatment treat- ment of Mental Health Conditions and Substance Abuse Use Disorder Conditions, including including, but not limited, lim- ited to the following:

Mental Health Service Administrator (MHSA. The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care. Blue Shield contracts with the MHSA to underwrite and deliver Blue Shield’s Mental Health and Substance Abuse Services Use Disorder Ser- vices through a separate network of MHSA Participating Partic- ipating Providers. Mental Health Services — services provided to treat a Mental Health Condition. MHSA Non-Participating Provider — a provider who does not have an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse Use Disorder Services. MHSA Participating Provider — a provider who has an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse Use Disorder Services. Network Specialty Pharmacy – select Participating Pharmacies contracted by Blue Shield to provide covered Specialty Drugs. These pharmacies offer 24-hour clinical services Negotiated Arrangement (Negotiated National Account Arrangement) — An agreement negoti- ated between a Control/Home Licensee and provide prompt home delivery of Specialty Drugsone or more Par/Host Licensees for any National Account that is not delivered through the BlueCard Pro- gram. Non-Participating or (Non-Preferred (Non- Participating Provider or Non-Preferred Provider) — refers to any provider who has not contracted with Blue Shield to be included in the EPO provider network and to accept Blue Shield’s payment, plus any applicable Member Deductible, Copayment, Coinsurance, or amounts in excess of specified Benefit maximums, as payment pay- ment in full for Covered Services provided to Members. This definition does not apply to providers of Mental Men- tal Health and Substance Abuse Use Disorder Services, which is defined separately under the MHSA Non-Non- Participating Provider definition. Non-Preferred Drugs Occupational Therapy — Drugs determined treatment under the di- rection of a Doctor of Medicine and provided by Blue Shielda certified occupational therapist, or other appropri- ately licensed Health Care Provider, utilizing arts, crafts, or specific training in daily living skills, to improve and maintain a patient’s Pharmacy and Therapeutics Committee as products that do not have a clear advantage over Formulary Drug alternativesability to func- tion. Benefits may be provided Office Visits for Non- Preferred Drugs and are always subject to the Non- Preferred Copayment or Coinsurance. Non-Routine Outpatient Mental Health and Substance Abuse Use Disorder Services – — professional office visits for the diagnosis and treatment of Mental Health and Substance Use Disorder Conditions, including the individual, family or group setting. Open Enrollment Period — that period of time set forth in the Contract during which eligible Em- ployees and their Dependents may enroll in this coverage, or transfer from another health benefit plan sponsored by the Employer to this coverage. Orthosis (Orthotics) — an orthopedic appliance or apparatus used to support, align, prevent or cor- rect deformities, or to improve the function of movable body parts. Other Outpatient Mental Health and Substance Use Disorder Services — Outpatient Facility and professional services for the diagnosis and treatment treat- ment of Mental Health Conditions and Substance Abuse Use Disorder Conditions, including including, but not limited, lim- ited to the following:

Mental Health Service Administrator (MHSA. The MHSA is a specialized health care service plan licensed by the California Department of Managed Health Care. Blue Shield contracts with the MHSA to underwrite and deliver Blue Shield’s Mental Health and Substance Abuse Services through a separate network of MHSA Participating Providers. Mental Health Services — services provided to treat a Mental Health Condition. MHSA Non-Participating Provider — —a provider who does not have an agreement in effect with the MHSA for the provision of Mental Health Services or Substance Abuse Services. MHSA Participating Provider — a provider who has an agreement in effect with the MHSA for the provision of Mental Health or Substance Abuse Services. Network Specialty Pharmacy – select Participating Pharmacies contracted by Blue Shield to provide covered Specialty Drugs. These pharmacies offer 24-hour clinical services and provide prompt home delivery of Specialty Drugs. Non-Participating or Non-Preferred (Non- Participating Provider or Non-Preferred Provider) — refers to any provider who has not contracted with Blue Shield to be included in the EPO provider network and to accept Blue Shield’s payment, plus any applicable Member Deductible, Copayment, Coinsurance, or amounts in excess of specified Benefit maximums, as payment in full for Covered Services provided to Members. This definition does not apply to providers of Mental Health and Substance Abuse Services, which is defined separately under the MHSA Non-Participating Provider definition. Non-Preferred Drugs — Drugs determined by Blue Shield’s Pharmacy and Therapeutics Committee as products that do not have a clear advantage over Formulary Drug alternatives. Benefits may be provided for Non- Preferred Drugs and are always subject to the Non- Preferred Copayment or Coinsurance. Non-Routine Outpatient Mental Health and Substance Abuse Services – Outpatient Facility and professional services for the diagnosis and treatment of Mental Health Conditions and Substance Abuse Conditions, including but not limited, to the following: