2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits


Note: The calendar year deductible applies to almost all benefits in this Section. We say “(No deductible)” when it does not apply.
 
Benefit Description
Professional Services
We cover professional services by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license.

You Pay
Your cost-sharing responsibilities are no greater than for other illnesses or conditions.
 
Benefit Description
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license

Outpatient professional services including:
  • Individual psychotherapy
  • Group psychotherapy
  • Pharmacologic (medication) management
  • Office visits
  • Clinic visits
  • Home visits

Notes:
  • We cover up to 4 visits per year in full to treat depression associated with pregnancy under maternity benefits (i.e., depression during pregnancy, postpartum depression, or both) when you use a Preferred provider. See page 48.
     
  • To locate a Preferred provider, visit www.fepblue.org/provider to use our National Doctor & Hospital Finder, or contact your Local Plan at the mental health and substance use disorder telephone number on the back of your ID card.
     
  • See pages 58 and 100 for our coverage of smoking, tobacco, and E-cigarette cessation treatment.
We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required.

You Pay
Preferred: $10 copayment (no deductible) per visit up to a combined total of 10 visits per calendar year (benefits combined with visits in Section 5(a), page 39)

Preferred provider, visits after the 10th visit: 30% of the Plan allowance

Non-preferred (Participating/Non-participating): You pay all charges
 
Benefit Description
Telehealth professional services for:
  • Behavioral health counseling
     
  • Substance use disorder counseling

Note: Refer to Section 5(h), Wellness and Other Special Features, for information on telehealth services and how to access our telehealth provider network.

You Pay
Preferred Telehealth Provider: Nothing (no deductible) for the first 2 visits per calendar year for any covered telehealth service received (benefits are combined with telehealth services listed in Section 5(a), page 39)

$10 copayment per visit (no deductible) after the 2nd visit

Non-preferred (Participating/Non-participating): You pay all charges
 
Benefit Description
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license:

 
  • Inpatient professional services
     
  • Professional charges for facility-based intensive outpatient treatment
     
  • Professional charges for outpatient diagnostic tests to include psychological testing

You Pay
Preferred: 30% of the Plan allowance

Non-preferred (Participating/Non-participating): You pay all charges
 

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professional
services
mental
health
substance
licensed
disorder
psychotherapy
individual
group
medication
management
office
visits
clinic
home
depression
pregnancy
maternity
baby
postpartum
website
smoking
tobacco
e-cigarettes
vaping
vape
cessation
treatment
telehealth
behavioral
counceling
addiction
inpatient
facility-based
intensive
outpatient
psycological
pharmacologic