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Mental Health & Substance Abuse Benefits

The benefits described on this page are provided to all eligible Active Participants in this Trust Fund and their eligible Dependents regardless of whether they are enrolled in the Blue Cross Network (PPO), Blue Cross Advantage Network (APPO), Kaiser (HMO) or Kaiser/Smart Choices (HMO), and to Retired Participants and their eligible Dependents enrolled in the Blue Cross Network (PPO) or Blue Cross Advantage Network (APPO) Plans only.

THERE IS NO BEAT IT! BENEFIT AVAILABLE TO RETIRED PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS ENROLLED IN ONE OF THE KAISER PLANS.

If you are enrolled in one of the Kaiser plans, you may have additional benefits through Kaiser.

Schedule of Mental Health and Substance Abuse Benefits

for Active Employees and their Dependents

 

Beat It!  (Contract PPO Providers) Anthem (Contract PPO Providers) Non-PPO Providers
Annual Deductible for families that participate in the Anthem Blue Cross Advantage Network (APPO) Plan

    • The Deductible is the amount you must pay each calendar year before the Plan pays benefits. The amount applied to the Deductible is the lesser of billed charges or the amount considered to be allowed under this Plan.
    • (Note that both Medical and Mental Health/Substance Abuse covered services accumulate to meet the same annual deductible)

 

None None $500 per Individual per calendar year

 

$1,000 per Family per calendar year

Annual Deductible for families that DO NOT participate in the Anthem Blue Cross Advantage Network (APPO) Plan

  • The Deductible is the amount you must pay each calendar year before the Plan pays benefits. The amount applied to the Deductible is the lesser of billed charges or the amount considered to be allowed under this Plan.
  • (Note that both Medical and Mental Health/Substance Abuse covered services accumulate to meet the same annual deductible)
None $1,000 per Individual or $1,000 per Family per calendar year

The $1,000 annual Deductible applies to all eligible charges (PPO and Non-PPO) except for PPO Preventive Care that is required to be covered under Health Reform and outpatient Prescription Drugs.

Hospital Emergency Room $100 Copay per visit (copay waived if admitted or under certain other conditions), then Plan pays 100% of Covered Expenses. After applicable Deductible met, you pay a $100 Copay per visit (copay waived if admitted or under certain other conditions), then Plan pays 100% of Covered Expenses.

 

If you are admitted to the Hospital, you must notify Anthem Blue Cross or Beat it! within 48 hours of admission.
Inpatient Services

  • Acute hospital admission
  • Residential Treatment Facility admission
Plan pays 100% of Contracted Rates After applicable Deductible met, Plan pays 100% of Contracted Rates After applicable Deductible met, Plan pays 50% of Allowed Charges
Inpatient admission to an acute hospital or residential treatment facility requires Prior Authorization by either Anthem Blue Cross or Beat it! to avoid a financial penalty, except for an emergency admission.

If you are admitted to the Hospital due to an emergency, you must notify Anthem Blue Cross or Beat it! within 48 hours of admission.

Outpatient Services

  • Office visit
  • Intensive Outpatient Program (IOP)
  • Partial Day Hospitalization
Plan pays 100% of Contracted Rates After applicable Deductible met Plan pays 100% of Contracted Rates After applicable Deductible met Plan pays 50% of Allowed Charges

 

 

Schedule of Mental Health and Substance Abuse Benefits for Active Employees and their Dependents enrolled in the Kaiser Premier HMO Plan or DHMO Plan

 

Beat It!  (Contract Providers) Non-Contract Providers
Annual Deductible for families that participate in the Kaiser Premier Plan or DHMO Plan

  • The Deductible is the amount you must pay each calendar year before the Plan pays benefits. The amount applied to the Deductible is the lesser of billed charges or the amount considered to be allowed under this Plan.
None None
Hospital Emergency Room You pay a $100 Copay per visit (copay waived if admitted or under certain other conditions), then Plan pays 100% of Covered Expenses.

If you are admitted to the Hospital, you must notify Beat it! within 48 hours of admission.

Inpatient Services

  • Acute hospital admission
  • Residential Treatment Facility admission
Plan pays 100% of Contracted Rates Plan pays 50% of Allowed Charges
Inpatient admission to an acute hospital or residential treatment facility requires Prior Authorization by Beat it! to avoid a financial penalty, except for an emergency admission.

If you are admitted to the Hospital due to an emergency, you must notify Beat it! within 48 hours of admission.

Outpatient Services

  • Office visit
  • Intensive Outpatient Program (IOP)
  • Partial Day Hospitalization
Plan pays 100% of Contracted Rates Plan pays 50% of Allowed Charges

 

Schedule of Mental Health and Substance Abuse Benefits for Non-Medicare Retired Employees and their Dependents

Beat It! (Contract PPO Providers) Anthem (Contract PPO Providers) Non-PPO Providers
Annual Deductible

  • The Deductible is the amount you must pay each calendar year before the Plan pays benefits. The amount applied to the Deductible is the lesser of billed charges or the amount considered to be allowed under this Plan.
  • (Note that both Medical and Mental Health/Substance Abuse covered services accumulate to meet the same annual deductible; Note also that both PPO and Non-PPO expenses accumulate separately to meet the annual deductible.)
None $300 per Individual per calendar year

$600 per Family per calendar year

$300 per Individual per calendar year

$600 per Family per calendar year

Annual Hospital Coinsurance Maximum

(See also the annual out-of-pocket limit on cost-sharing described in the Schedule of Medical Benefits)

$2,000 per person (does not include the Calendar Year Deductible) $2,000 per person (does not include the Calendar Year Deductible) None
Hospital Emergency Room $100 Copay per visit (copay waived if admitted or under certain other conditions), then Plan pays 100% of Covered Expenses. After Deductible met, you pay a $100 Copay per visit (copay waived if admitted or under certain other conditions), then Plan pays 100% of Covered Expenses.

 

If you are admitted to the Hospital, you must notify Anthem Blue Cross or Beat it! within 48 hours of admission.
Inpatient Services

  • Acute hospital admission
  • Residential Treatment Facility admission
Plan pays 80% of Contracted Rates After Deductible met, Plan pays 80% of Contracted Rates After Deductible met, Plan pays 50% of Allowed Charges
If you are not yet eligible for Medicare, prior authorization by either Anthem Blue Cross or Beat It! is required except for Emergencies
Outpatient Services

  • Office visit
  • Intensive Outpatient Program (IOP)
  • Partial Day Hospitalization
Plan pays 100% of Contracted Rates Plan pays 100% of Contracted Rates, deductible does not apply. After Deductible met, Plan pays  50% of Allowed Charges

Information Needed

Whom to Contact

Mental Health and Chemical Dependency Benefits

(for Active/Retired participants and eligible Dependents enrolled in the Blue Cross Network (PPO), Blue Cross Advantage Network (APPO); and also for Active participants and eligible dependents enrolled in the Kaiser (HMO) and Kaiser/Smart Choices (HMO)

  • Referrals and prior authorization
  • Mental Health and Chemical Dependence Providers
  • Behavioral Health Claims and Appeals
Beat it!
P.O. Box 20896
San Jose, CA 95160
Toll Free: 1-800-828-3939

This program provides benefits for the Blue Cross Network (PPO), Blue Cross Advantage Network (APPO), the Kaiser (HMO) and the Kaiser/Smart Choices (HMO) (and their Dependents). However, if you and/or your family are in Kaiser, you also have the option of using your HMO benefits.

Blue Cross – See the Quick Reference Chart
Kaiser – See the Quick Reference Chart