2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits
Residential Treatment Center
Section 5(e). Mental Health and Substance Use Disorder Benefits
Residential Treatment Center
Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.
Benefit Description
Residential Treatment Center
Precertification prior to admission is required.
We cover inpatient care provided and billed by an RTC when the care is medically necessary for the treatment of a medical, mental health, and/or substance use disorder:
Notes:
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred (Member/Non-member) facilities: You pay all charges
Benefit Description
Residential Treatment Center
Precertification prior to admission is required.
We cover inpatient care provided and billed by an RTC when the care is medically necessary for the treatment of a medical, mental health, and/or substance use disorder:
- Room and board, such as semiprivate room, nursing care, meals, special diets, ancillary charges, and covered therapy services when billed by the facility
Notes:
- RTC benefits are not available for facilities licensed as a skilled nursing facility, group home, halfway house, or similar type facility.
- Benefits are not available for noncovered services, including: respite care; outdoor residential programs; services provided outside of the provider’s scope of practice; recreational therapy; educational therapy; educational classes; biofeedback; Outward Bound programs; hippotherapy/equine therapy provided during the approved stay; personal comfort items, such as guest meals and beds, phone, television, beauty and barber services; custodial or long term care (see Definitions); and domiciliary care provided because care in the home is not available or is unsuitable.
- For outpatient residential treatment center services, see next page.
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred (Member/Non-member) facilities: You pay all charges