Specialized mental health and chemical dependency services are provided under a single program available to all employees enrolled in any of the state’s health plans. This program, currently administered by United Behavioral Health (UBH), also known as OptumHealth Behavioral Solutions, provides 24-hour-a-day, seven-day-a-week telephonic assessment and referral services for a variety of behavioral health issues, such as:
- Depression
- Stress
- Marital and family issues
- Serious mental illnesses
- Alcohol and drug dependency
The program also includes a disability component in which employees who require time off for behavioral health conditions have access to specialized providers on an expedited basis.
Behavioral Health Benefit Plan Design effective July 1, 2011
Click here to view the HMO benefit plan design changes prior to July 1, 2011
Click here to view the Ohio Med plan PPO mental health program benefit changes prior to July 1, 2011
Click the links below to access the information you need quickly.
Ohio Employee Assistance Program
United Behavioral Health
Summary Plan Description (Document will load in :05 seconds)
Key Points
How do I use Behavioral Health Insurance?
Access a list of participating providers
Emergency Care
Care While Traveling
Cost
Coverage
Eligibility
Claim Process
Key Points:
- There are no limits on the number of clinically necessary visits or inpatient days under the program.
- There are no annual or lifetime monetary maximums.
- Patients should obtain pre-approval for all services and should utilize providers, hospitals and other facilities that participate in the UBH network in order to obtain the highest level of benefits. Access to the UBH behavioral health care system may also be coordinated through the State of Ohio internal Employee Assistance Program administered by the Ohio Department of Health at 1.800.221.6327.
How Do I Use My Behavioral Health Insurance?
UBH calls are answered by master’s degree level, licensed clinicians who are trained to assist callers with emergency, urgent or routine issues and assist them in locating an appropriate provider. Routine Care For outpatient counseling services, you may obtain assistance in locating a participating provider experienced in dealing with your specific issues. If you have a previously-established relationship with a counselor, or if one has been recommended by your physician, call 1.800.852.1091 to ask UBH if the provider participates in the UBH network.
Access a list of participating providers
You may also access a list of participating providers by visiting the UBH Web site at www.liveandworkwell.com and by selecting “Find a clinician near you." Enter the State of Ohio access code of 00832 to enter the site or register as a user by creating a user name and password.
Emergency Care
If you or a loved one experiences a life threatening emergency that requires immediate attention, go to the nearest emergency room. It is best if you can contact UBH before your arrival. If you cannot, call UBH at 1.800.852.1091 within 24 hours. (In most cases, emergency care is covered by your medical plan.) If the emergency room visit is going to result in an admission to the hospital for a behavioral health or chemical dependency condition, you or the facility must call UBH for authorization. You may be directed to a more appropriate inpatient or outpatient facility for treatment.
Care While Traveling
UBH has a nationwide network of providers and hospitals. Call 1.800.852.1091 for assistance in obtaining services when outside of the Ohio service area.
What Costs Are Involved?
For Ohio Med PPO members: Outpatient Care
Employees and dependents are required to pay a $20 copayment for each in-network outpatient visit. For out-of-network visits, a $30 per visit copayment applies and then the plan pays 60% of the allowed amount. You may be subject to balance billing for amounts above the allowable amount. You should contact United Behavioral Health before seeking care to ensure the highest level of benefits. Office visit copayments do not count toward your deductible.
For Ohio Med PPO members: Inpatient Care
For in-network hospital care you must pay 100% of the charges until your deductible has been met, and then 20% of the charges until your annual out-of-pocket maximum has been met. For out-of-network hospital care you must pay 100% of the charges until your deductible has been met and then 40% of the charges until your out-of-pocket maximum is met and you may be subject to balance billing over the allowed amounts. Coinsurance amounts made for mental health and substance abuse services count toward your health plan deductible and out-of-pocket maximums. Once you have reached your annual out-of-pocket maximum, all charges will be covered in full.
What's Covered?
Individual and group outpatient mental health and substance abuse treatment Inpatient psychiatric and chemical dependency treatment Family and marital counseling Services for lifestyle management counseling Mental health and substance abuse disorders and conditions, including, but not limited to:
- Assessment
- Diagnosis
- Individual and group psychotherapy
- Inpatient treatment
- Intensive outpatient services
- Medication management
- Preventive services
- Treatment planning
Additionally, wellness classes are available on a group basis. Classes on weight management, smoking cessation, fitness and nutrition are among those available on a group basis free to state employees. A minimum of six individuals at a worksite must participate in order for the UBH trainer to conduct a class or series. Classes are suitable for adults age 18 and older, and are provided at your worksite. To host a wellness class, contact UBH at 614.410.7355.
You should call UBH at 1.800.852.1091 before seeking services to ensure you will receive the highest level of benefits. If your medical plan is a Health Maintenance Organization (HMO) you must use UBH participating providers and facilities. Out-of-network services are not covered. If you medical plan is the Ohio Med PPO, you may use out-of-network providers but at a greatly reduced benefit level.
Visit UBH's Web site at www.liveandworkwell.com and enter access code 00832 to find:
- Participating providers
- Health and wellness information
- Mental health conditions
- Online assessments
- Educational tools
Eligibility
Eligibility for Services: Services are available to all employees and their dependents that are enrolled in any of the state-sponsored health care plans. There is no need to enroll separately for these benefits. Employees who are not enrolled in a health care plan are not eligible. Health plan providers will not provide mental health and substance abuse services.
Effective Date of Coverage
Coverage is effective on the same date that your health care plan becomes effective, which is the first day of the month following the month in which you enroll in a health care plan, or the first day of the new benefit period.
What’s not covered?
Some problems that may be thought of as mental health or substance abuse related problems are not covered by United Behavioral Health.
*These include, but are not limited to:
- Conditions requiring long term care in custodial settings such as nursing homes
- Conditions for which treatment is court-ordered but not medically necessary, such as weekend programs for driving under the influence of alcohol or drugs
- Examinations for employment, licensing, school, camp, sports, insurance, adoptions or other non-medically necessary reasons
- Food supplements, liquid diets, diet plans or any related education requirement
- Herbal medicine
- Nicotine replacement products
- Nutritional counseling, membership costs for health clubs and weight loss clinics, and similar programs
- Report preparation and presentation
- Services provided in an institution that is mainly a school, camp or other training institution
- Services that are considered investigational
- Sex change therapy or transsexualism
- Some organic conditions such as chronic organic brain syndrome
- Treatment given in connection with mental retardation, autism, pervasive development disorders and learning disabilities
*Note: This list is not all inclusive; please contact UBH before receiving services.
Claim Process
In most cases, there are no forms to complete. Employees and dependents simply attend appointments and pay the required copayments, deductibles, and coinsurance. In rare situations, such as emergency care, claim forms may be necessary. You must file your claim within 15 months of the date services occurred.
UBH will send you an explanation of benefits (EOB) form which explains how each claim was paid or why it was denied. Requests for reviews of denied claims must be made within 90 days of the date the claim was processed. You may review your EOB’s on-line by visiting www.liveandworkwell.com and registering on the site.
If you have any questions or disagree with a UBH benefit decision, call the UBH Member Relations Department at 1.800.852.1091 Monday through Friday between 9 a.m. and 8 p.m. EST. A representative will assist you with your request and inform you of your options for further review if you remain dissatisfied.