2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(e). Mental Health and Substance Use Disorder Benefits
Page 84
Section 5(e). Mental Health and Substance Use Disorder Benefits
Page 84
Benefit Description
Outpatient Hospital or Other Covered Facility (cont.)
Note: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required. Failure to obtain prior approval will result in a $100.00 penalty. See Section 3.
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred (Member/Non-member) facilities: You pay all charges
Outpatient Hospital or Other Covered Facility (cont.)
Note: We cover outpatient mental health and substance use disorder services or supplies provided and billed by residential treatment centers at the levels shown here. Prior approval is required. Failure to obtain prior approval will result in a $100.00 penalty. See Section 3.
You Pay
Preferred facilities: 30% of the Plan allowance (deductible applies)
Non-preferred (Member/Non-member) facilities: You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Educational or other counseling or training services
- Services performed by a noncovered provider
- Testing for and treatment of learning disabilities and intellectual disability
- Inpatient services performed or billed by residential treatment centers, except as described earlier in this section and in Section 5(c)
- Services performed or billed by schools, halfway houses, group homes or members of their staffs
Note: We cover professional services as described in Section when they are provided and billed by a covered professional provider acting within the scope of their license.
- Psychoanalysis or psychotherapy credited toward earning a degree or furtherance of education or training regardless of diagnosis or symptoms that may be present
- Services performed or billed by residential therapeutic camps (e.g., wilderness camps, Outward Bound, etc.)
- Light boxes
- Custodial or long-term care (see Definitions)
- Costs associated with enabling or maintaining providers’ telehealth (telemedicine) technologies, non-interactive telecommunication such as email communications, or asynchronous store-and-forward telehealth services
You Pay
All charges