BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Mental Health Inpatient
80% after plan deductible
50% after plan deductible
Includes Acute Inpatient and Residential Treatment
Calendar Year Maximum: Unlimited Outpatient Outpatient - Office Visits
$30 per visit copay
50% after plan deductible
Includes individual, family and group psychotherapy; medication management, Behavioral Telehealth consultation, etc.
Calendar Year Maximum: Unlimited
Outpatient - All Other Services Includes Partial Hospitalization, Intensive Outpatient Services, Behavioral Telehealth consultation, etc.
80% after plan deductible
50% after plan deductible
Calendar Year Maximum: Unlimited
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