Your Health Care Benefits

Mental Health and Substance Abuse Benefits

You and your family members are eligible to receive inpatient or outpatient care for the treatment of mental health and substance abuse. The Plan will pay for covered expenses, including hospitalization and psychological testing, if clinically appropriate.

! Benefit navigation with the EAP for any mental health or substance abuse treatment is available. Contact the EAP by calling 1-800-765-3277.

Fast Facts

  • Outpatient treatment is payable at 80% of the allowance, after you’ve satisfied your annual deductible.
  • Inpatient treatment is payable at 100% of the allowance up to the first $7,000. After the first $7,000, you’ll be reimbursed for expenses at 80% of the allowance for each spell of illness.
  • Charges for mental health and substance abuse are expenses included in the calculation of Lifetime Benefits and Annual Limits.
  • Mental health and substance abuse benefits are not available to H Plan participants, but H Plan participants may use the EAP to seek assistance with mental health and substance abuse issues (see here).

What You Need To Do

  • Contact the EAP at 1-800-765-3277 for benefit navigation before beginning any course of mental health or substance abuse treatment.
  • Set-up an appointment to meet with an EAP counselor for an assessment and, if appropriate, a referral.
  • If you are referred to a provider for treatment, be sure to show your EWTF ID card to receive the Plan discounts.
  • Give the provider the group number 78-340001. The provider should make sure this number is on each claim that is submitted on your behalf.

Free Benefit Navigation with the EAP

Before beginning any course of psychological treatment or treatment for substance abuse, you should contact the EAP (Business Health Services) at 1-800-765-3277 to set up an appointment for a “face to face” assessment and if appropriate, a referral.

Outpatient Benefits

Benefits for outpatient treatment for mental health and substance abuse are paid at 80% of the allowance once the annual deductible has been met. Services must be provided by an M.D., Ph.D., or a licensed social worker working under the supervision of a doctor (M.D. or Ph.D.) or approved by a BHS counselor.

All other outpatient expenses are paid at the percentage indicated in the Summary of Benefits and are subject to the annual deductible and the annual and lifetime benefits. Outpatient services may be rendered by a physician, psychiatrist, psychologist or a duly licensed and certified social worker (if the services are clinically appropriate and given under the supervision of a physician).

Inpatient Benefits

The first $7,000 of eligible expenses for room and board and other covered hospital services are paid in full. Any charges you incur that exceed $7,000 is paid at 80% of the allowance.

Psychological Testing

Benefits are payable at 80% of the allowance subject to the annual deductible. When psychological testing has been ordered to determine if the patient has Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), contact BHS for benefit navigation and referral to a provider of service.

Free Benefit Navigation will help direct you to the appropriate mental health professional

Benefit Navigation is available for all mental health and substance abuse benefits through the EWTF’s Employee Assistance Program. Call 1-800-765-3277 for benefit navigation services.

Filing Claims

If you use a participating provider, your claims should be mailed to:

UnitedHealthcare Integrated Services
PO Box 30783
Salt Lake City, UT 84130-0783

EWTF Group Number

! The group number for EWTF is 78-340001. The group number should be given to each provider and put on each claim submitted.

What’s Not Covered

The Plan does not provide benefits for:

  • court ordered treatment
  • marriage counseling (this is one of the services that may be resolved during the eight free sessions provided through the EAP)

See “Expenses that are Not Covered” for more information.