Mental Health & Substance Abuse Benefits
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
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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
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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
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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. |
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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.
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If you are admitted to the Hospital, you must notify Anthem Blue Cross or Beat it! within 48 hours of admission. | |||
Inpatient Services
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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. |
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Outpatient Services
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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
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Beat It! (Contract Providers) | Non-Contract Providers | |
Annual Deductible for families that participate in the Kaiser Premier Plan or DHMO Plan
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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. |
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Inpatient Services
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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. |
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Outpatient Services
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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 |
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Beat It! (Contract PPO Providers) | Anthem (Contract PPO Providers) | Non-PPO Providers | |||
Annual Deductible
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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 |
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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.
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If you are admitted to the Hospital, you must notify Anthem Blue Cross or Beat it! within 48 hours of admission. | |||||
Inpatient Services
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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
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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)
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Beat it! 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 |