OptumHealth Mental Health Benefits
Benefit Description
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 Health Benefits
| Inpatient Deductible | None |
| Inpatient Per Admission Fee | Same as Medical Plan |
| Impatient, 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 |
| Impatient, Partial and Day Treatment | Unlimited days covered at 100% after any applicable admission fee |
| Annual Maximum Benefit for Inpatients Treatment | None |
| 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. | |