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Q.
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What is a Member Assistance Program (MAP)?
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A.
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A Member Assistance Program (MAP) is a confidential counseling and referral service. Most programs are proactive in problem solving, early intervention and prevention. Usually staff members are trained in a wide variety of issues, including financial and legal matters, child and elder care, and drug/alcohol addictions to name a few. The ultimate goal is to help you and your family lead happy and productive lives.
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Q.
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Are these Benefits Confidential?
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A.
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Yes, all MAP and mental health/chemical dependency services are strictly confidential and protect you at all stages of the program. No information is released to a family member, employer, or anyone else, unless you sign a confidentiality release. Federal and State confidentiality laws apply.
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AUTOMOTIVE INDUSTRIES WELFARE FUND
(for Direct Pay Enrollees Only)
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PacifiCare
Behavioral Health Care Plan
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Q.
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How do I access Benefits?
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A.
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All you need to do is call PBH at their toll-free number 800/491-3334, available 24 hours a day, seven days a week. The representative will check your eligibility, gather basic information and ask a few questions to determine the type of service you need. At this point, you will be referred to a network provider or program near your home or worksite. They can help you make that first appointment.
If you choose to see your own provider for outpatient mental health visits, no pre-authorization is required. Just submit your provider's bill for reimbursement to PacifiCare Behavioral Health at 23046 Avenida de la Carlota, Suite 700, Laguna Hills, CA 92653.
If you have a legal issue, you will be referred to the legal hotline for a free 30 minute consultation. Or if you need help with the family budget or have child/elder care issues, you may be referred to a community resource near you.
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Q.
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What do Mental Health & Chemical Dependency Benefits cover?
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These include complete inpatient programs and outpatient counseling visits with a licensed provider and structured residential, day and inpatient treatment programs for problems and disorders such as:
- Depression
- Stress & Anxiety
- Marriage/family issues
- Serious mental illness
- Drug/alcohol addictions
These benefits are available for you and your eligible family members. Inpatient benefits must be pre-authorized. In an emergency, however, the first concern is your health and well-being. Within 24 hours of admission call 1-800-491-3334.
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Summary of Benefits
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Member Assistance Program (MAP)
- 1-3 MAP sessions per calendar year at no cost
- 24 hour toll-free access
- Referrals to community resources
Mental Health Outpatient Coverage
50 visits per calendar year (combined in-network & out-of-network)
In-Network
- Visits 1-5, no copayment per visit
- Visits 6-10, $10 copayment per visit
- Visits 11-15, $20 copayment per visit
- Visits 16-50, $30 copayment per visit
Out of Network
- Visits covered at 50% of Usual, Customary, and Reasonable (UCR) fees.
Mental Health Inpatient Coverage
- In-Network coverage only
- 90% coverage - 30 days per calendar year
Chemical Dependency Coverage
- All chemical dependency treatment must be pre-authorized
- 2 treatment programs per calendar year per member
- Lifetime maximum of 3 treatments programs
- $35,000 per calendar year per member
- $50,000 lifetime maximum
- In-Network coverage level of 50% of UCR
- $250 deductible per calendar year
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