OptumHealth Mental Health Benefits

Benefit Description

Mental health benefits by OptumHealth Behavioral Solutions are provided to Self-Funded enrolled participants. Kaiser participants receive Mental Health benefits from Kaiser.

Benefit Highlights

Pre-authorization is required for all Inpatient and Outpatient and Serious Mental Illness benefits.

Serious Mental Illness diagnosis include: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depressive Disorder, Panic Disorder, Obsessive-Compulsive Disorder, Pervasive Developmental Disorders (Autism), Anorexia, Bulimia Nervosa, Severe Emotional Disturbances of Children (SED).

Chemical Dependency Benefits
Chemical Dependency benefits are provided by OptumHealth Behavioral Solutions to all participants and their eligible dependents regardless of their medical plan.

Schedule Of Chemical Dependency Benefits
All levels of chemical dependency care includes detox.

  • $25,000 Annual Maximum
  • $0 copay and covered at 100%
  • $35,000 Lifetime Maximum

Pre-authorization is required for all Chemical Dependency benefits. Contact OptumHealth Behavioral Solutions 24 hours a day, 7 days a week toll-free at 1-877-225-2267.

Schedule of Mental Heath Benefits

Inpatient deductible None
Inpatient per admission fee Same as medical plan
Inpatient, partial and day treatment 30 days per calendar year* covered at 100% after any applicable admission fee
*Days to be determined based on the following ratios:
Inpatient treatment 1 day
Residential treatment 70% of 1 day
Day treatment 60% of 1 day
Outpatient mental health 30 visits $5 co-payment per visit

Serious Mental Illness Benefits

Inpatient deductible None

Inpatient per admission fee

 Same as medical plan
Inpatient, partial and day treatment Unlimited days covered at 100% after any applicable admission fee
Annual maximum benefit for inpatient treatment None
Lenticular lenses $125
Outpatient mental health treatment Unlimited visits, $5 co-payment per visit
Lifetime Dollar Maximum for Parity Diagnosis: Applied to medical plan lifetime dollar maximum benefit

Optum Mental Health Care Documents

A full description of all benefits, including any benefits not described on this website, are found in the Summary Plan Description.

Optum Mental Health Services