Mental Health and Chemical Dependency Care
- Special Rules
- Mental Health PPO
- Mental Health Care Outside the United States
Mental Health and Chemical Dependency Care
The POS II options include a number of provisions specific to mental health and chemical dependency treatment.
All outpatient and inpatient mental health and chemical dependency care should be pre-certified by Magellan Behavioral Health. Pre-certification for inpatient care may be required. The health care provider is responsible for obtaining pre-certification for inpatient network care. The participant is responsible for obtaining pre-certification for services for inpatient non-network and out-of-network care; if pre-certification is not obtained, a $500 penalty will be assessed for failure to pre-certify inpatient non-network and out-of-network care.
Pre-certification is required even if the Plan is secondary to other medical coverage. Whenever treatment for mental health or chemical dependency is needed, call Magellan Behavioral Health. The telephone numbers are shown in the Information Sources section at the front of this SPD.
When you talk to the specially trained Magellan counselor, he or she will discuss your needs with you. For employees and their family members, this service is available through ExxonMobil's Employee Health Advisory Program (EHAP). EHAP is not available to retirees and their covered family members who have not elected COBRA. In some cases, up to eight sessions with a counselor are available at no cost to you. However, if more intense or specialized services are needed than are available through EHAP, you may be referred to a network provider immediately upon evaluation. If more treatment or specialized services not offered by EHAP are needed after you have attended some EHAP sessions, the counselor will offer you a choice of network providers in the appropriate specialty area.
Expenses for emergency care at a MHPPO facility will be reimbursed at the 80% benefit level for the POS II "B" or 75% for the POS II "A".
If the patient is admitted and the emergency facility does not participate in the MHPPO, Magellan will work with the emergency care treatment team to arrange a transfer to a MHPPO facility as soon as possible after the patient is stabilized. Expenses for emergency care at a non-network MHPPO facility will be reimbursed at the 60% benefit level for the POS II "B" or 55% for the POS II "A".
If you require mental health or chemical dependency care in conjunction with a medical emergency, you must notify Magellan within the time periods described above.
The Mental Health PPO (MHPPO) is a nationwide network of providers who offer quality, cost-effective care. MHPPO providers work with Magellan Behavioral Health to develop suitable treatment plans and provide needed services.
If You Use Mental Health Network Providers
For inpatient mental health and chemical dependency treatment to be reimbursed at the network level, both the provider and the facility must participate in the MHPPO network. If either the provider or the facility is non-network, all expenses associated with the confinement will be reimbursed at the non-network level.
If You Do Not Use Mental Health Network Providers
Example — Payment of Network and Non-Network Expenses for Inpatient Mental Health and Chemical Dependency Cases:
Assume you participate in the POS II "B" option and submit a claim for covered inpatient expenses to the Plan. Magellan determines that network charges for your treatment would be $15,000. Also assume that a non-network provider charged $19,000 for the same service. Assume the inpatient hospital deductible of $150 for network and $300 for non-network has been met for the year. Here is how payment of both network and non-network certified and non-certified expenses would compare:
If you live or travel outside the United States and need treatment for a mental health or chemical dependency condition, you should contact Magellan Behavioral Health.
Currently, there are no network providers outside the United States. However, Magellan will recommend providers with whom they have experience. Treatment received is reimbursed at 80% for the POS II "B" and 75% for the POS II "A" after you satisfy the annual deductible. The same emergency care procedures apply inside and outside the United States.