OF ELECTRICAL WORKERS
LOCAL UNION 570
The Fund has an administrative services contract with Blue Cross Blue Sheild to provide referrals and treatment for inpatient and/or outpatient mental health and substance abuse. Referrals and benefits are also provided for stress-related problems and smoking cessation (up to four counseling sessions for smoking cessation, to be treated as Preventive Care).
Whenever you or one of your Dependents is in need of inpatient or outpatient care and/or treatment as a result of one of the situations mentioned above, you should contact Blue Cross Blue Sheild at (800) 851-7498 or www.bebsil.com. A Blue Cross Blue Sheild representative will refer you to one of its providers.
To the fullest extent permitted by the Mental Health Parity Act, Blue Cross Blue Sheild representative must also pre-clarify any inpatient services and any partial hospitalization, residential treatment center and intensive outpatient treatment, including Intensive Outpatient Programs; Applied Behavioral Analysis; Outpatient Electroconvulsive Therapy; Repetitive Transcranial Magnetic Stimulation; and various Psychological and Neuro-Psychological testing. Failure to pre-clarify results in a $250 penalty.
Covered mental health and substance abuse services are subject to the same overall combined deductibles and coinsurance rates and out-of-pocket maximum that apply to the Fund’s comprehensive medical benefits. There are no stand-alone separate deductibles, coinsurance or maximum out-of-pocket limits for mental health and substance abuse benefits. This means that the same $400 individual (and $88 family) deductible applies to covered mental health and substance abuse benefits as also applies to comprehensive medical benefits. In addition, in-patient mental health and substance abuse benefits are subject to the Fund’s $200 non-PPO hospital deductible. After meeting applicable deductibles, just like comprehensive medical benefits, PPO services will be covered at the 80% coinsurance rate, up to the annual combined Major Medical / Mental Health out-of-pocket maximum of $4,400 individual and $8,800 family, after which in-network care is paid at 100%. Non-PPO services will always be covered at the 55% of reasonable and customary cost coinsurance rate; there is no out-of-pocket maximum. “Reasonable and Customary” for Non-PPO facilities is capped at 200% of the Medicare allowable. You are also responsible for any charges over the reasonable and customary limit.