2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(e). Mental Health and Substance Use Disorder Benefits
Page 99
Section 5(e). Mental Health and Substance Use Disorder Benefits
Page 99
Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Section. There is no calendar year deductible under Basic Option.
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.
Standard Option - You Pay
Your cost-sharing responsibilities are no greater than for other illnesses or conditions.
Basic Option - You Pay
Your cost-sharing responsibilities are no greater than for other illnesses or conditions.
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.
Standard Option - You Pay
Your cost-sharing responsibilities are no greater than for other illnesses or conditions.
Basic Option - 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
Note: 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 phone number on the back of your ID card.
Note: See pages 61 and 117 for our coverage of smoking and tobacco cessation treatment.
Note: See page 47 for our coverage of mental health visits to treat postpartum depression and depression during pregnancy.
Note: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here.
Standard Option - You Pay
Preferred: $25 copayment for the visit (no deductible)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus the difference between our allowance and the billed amount
Basic Option - You Pay
Preferred: $30 copayment per visit
Participating/Non-participating: You pay all charges
Services provided by licensed professional mental health and substance use disorder practitioners when acting within the scope of their license
- Individual psychotherapy
- Group psychotherapy
- Pharmacologic (medication) management
- Psychological testing
- Office visits
- Clinic visits
- Home visits
- Phone consultations and online medical evaluation and management services (telemedicine)
Note: 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 phone number on the back of your ID card.
Note: See pages 61 and 117 for our coverage of smoking and tobacco cessation treatment.
Note: See page 47 for our coverage of mental health visits to treat postpartum depression and depression during pregnancy.
Note: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here.
Standard Option - You Pay
Preferred: $25 copayment for the visit (no deductible)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus the difference between our allowance and the billed amount
Basic Option - You Pay
Preferred: $30 copayment per visit
Participating/Non-participating: You pay all charges
Benefit Description
Telehealth professional services for:
Note: Refer to Section 5(h), Wellness and Other Special Features, for information on telehealth services and how to access our telehealth provider network.
Note: Benefits are combined with telehealth services listed in Section 5(a), page 39.
Note: Copayments are waived for members with Medicare Part B primary.
Standard Option - You Pay
Preferred Telehealth provider: Nothing (no deductible) for the first 2 visits per calendar year for any covered telehealth service
$10 copayment per visit (no deductible) after the 2nd visit
Participating/Non-participating: You pay all charges
Basic Option - You Pay
Preferred Telehealth provider: Nothing for the first 2 visits per calendar year for any covered telehealth service
$15 copayment per visit after the 2nd visit
Participating/Non-participating: You pay all charges
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.
Note: Benefits are combined with telehealth services listed in Section 5(a), page 39.
Note: Copayments are waived for members with Medicare Part B primary.
Standard Option - You Pay
Preferred Telehealth provider: Nothing (no deductible) for the first 2 visits per calendar year for any covered telehealth service
$10 copayment per visit (no deductible) after the 2nd visit
Participating/Non-participating: You pay all charges
Basic Option - You Pay
Preferred Telehealth provider: Nothing for the first 2 visits per calendar year for any covered telehealth service
$15 copayment per visit after the 2nd visit
Participating/Non-participating: You pay all charges
Professional Services - continued on next page