Department of Finance & Administration
Dave Goetz, Commissioner
Benefits Administration
Mental Health and Substance Abuse
Employees and their dependents enrolled in health coverage are eligible for mental health and substance abuse services which are administered by Magellan Health Services. To receive maximum benefit coverage, participants must use a network provider and obtain preauthorization. Magellan can be reached toll-free at 1.800.308.4934 any time, day or night, to speak confidentially with a trained professional for a referral. Under the PPO option, participants may see an out-of-network mental health provider without calling for a referral; however, coinsurance and copayments will be higher. Participants are also at risk of having inpatient benefits totally denied. Under the POS and HMO healthcare options, both outpatient and inpatient services must be preauthorized to a network provider prior to the delivery of the service or benefits will be denied.
| PPO | POS | HMO | ||
| In-Network | Out-of-Network | In-Network Only | In-Network Only | |
| Mental Health Inpatient | 90% of MAC; Limited to 45 days per year *PPO Ltd 80% of MAC |
70% of MAC; Limited to 45 days per year *PPO Ltd 60% of MAC |
$100 copay per admission; Limited to 30 days per year |
$100 copay per admission; Limited to 30 days per year |
| Substance Abuse Inpatient | 90% of MAC; Limited to two 5-day detox stays per lifetime; plus two 28-day lifetime stays *PPO Ltd 80% of MAC |
70% of MAC; Limited to two 5-day detox stays per lifetime; plus two 28-day lifetime stays *PPO Ltd 80% of MAC |
$100 copay per admission; Limited to two 5-day detox stays per lifetime; plus two 28-day lifetime stays |
$100 copay per admission; Limited to two 5-day detox stays per lifetime; plus two 28-day lifetime stays |
| Mental Health and Substance Abuse Outpatient | Sessions 1-15: $5 copay per session Sessions 16-45: $25 copay per session Limited to 45 sessions per year mental health and substance abuse combined |
Sessions 1-15: $40 copay per session Sessions 16-45: $100 copay per session Limited to 45 sessions per year mental health and substance abuse combined |
$25 copay per session; Limited to 45 sessions per year mental health and substance abuse combined |
$20 copay per session; Limited to 45 sessions per year mental health and substance abuse combined |
| Deductible | $150 per individual (separate from medical deductible) |
None |
None |
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