SECTION FOUR
Mental Health and Substance Abuse Services
October, 2007

Mental health and substance abuse services are provided by United Behavioral Health (UBH) to employees and their dependents who are enrolled in a state-sponsored health care plan. UBH offers a comprehensive program of mental health, substance abuse and lifestyle management treatment services for you and your family members.

Additional information about UBH services, health and wellness, educational tools, mental health conditions and online assessments can be found at www.liveandworkwell.com. Use Access Code 00832 to enter the customized site for State of Ohio employees.

All of these services are provided exclusively by an extensive statewide network of psychiatrists, psychologists, licensed independent social workers, licensed professional clinical counselors, chemical dependency counselors, masters level nurses, and other mental health providers. Services are typically provided at individual network providers’ local offices.

Included are individual and group outpatient mental health and substance abuse treatment, inpatient psychiatric and chemical dependency treatment, family and marital counseling, and services for lifestyle management counseling. There are no deductibles and no predetermined maximum number of visits or hospital admissions associated with this program. There is a $15 copayment for each outpatient visit and a $100 copayment for each hospital stay, after which the plan pays 100%.

Eligibility for Services
Services are available to all employees and their dependents who 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. Neither Ohio Med nor the HMOs will 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: 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.

How to Use These Services
Employees and their family members who wish to receive any mental health or substance abuse treatment must call a UBH intake couselor for authorization before receiving services. You may contact UBH 24 hours a day, seven days a week by calling (800) 852-1091.

Your call will be answered by a licensed Intake Coordinator who will ask you for some general information including your name, phone number, the policyholder’s Social Security number and a brief description of your reason for calling. UBH will work with you to identify a licensed provider who is in the UBH network of providers, is convenient to your home or workplace and who specializes in treating the issues you have described.

You may request a specific type of network provider who is appropriate to your situation. Once you have been given the name and phone number of a network provider, you should contact the provider for an appointment within 24 hours.

If you prefer, you also may access UBH services through the Ohio Employee Assistance Program by calling (800) 221-6327, or TDD/TTY (614) 752-6379.

There are no benefits for services which are not preauthorized and provided by a UBH participating provider, except in emergency situations.

Cost of Services
Employees and dependents are required to pay a $15 copay for each outpatient visit and a $100 copay for each hospital admission. Beyond these copays, all services that have been preapproved by UBH will be covered in full. Copays made for mental health and substance abuse services do not count toward your health plan deductible and out-of-pocket maximums.

Covered Services
UBH covers a wide variety of mental health and substance abuse disorders and conditions. Services include, but are not limited to:

The above services must be determined clinically necessary by UBH and be provided by a UBH network provider. You must call UBH at (800) 852-1091 to request authorization before seeking services.

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.

Emergency Care
If you or a family member require emergency treatment, call UBH at (800) 852-1091 for a referral to a participating facility. If you are unable to call prior to receiving services, you or your representative must call UBH within 24 hours of receiving care. Failure to do so may result in the denial of payment for the services you received. When the emergency care is complete, you must call UBH before any additional services will be covered.

Out-of-State Services
If you need care while you are away from home, call UBH at (800) 852-1091. There are UBH providers all over the country so the Intake Coordinator can help you get the treatment you need.

Exclusions
Some problems that may be thought of as mental-health or substance-abuse related problems are not covered by UBH. These include, but are not limited to:

Because this list is not all inclusive, please contact UBH before receiving services.

Filing Claims
In most cases, there are no forms to complete. Employees and dependents simply attend appointments and pay the required copayments. 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 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.

If you have any questions or disagree with a UBH benefit decision, call the UBH Member Relations Department at (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.