Behavioral health

Psychiatric residential and rehabilitation facilities

You and your children (under 21) are covered if you need to stay in a treatment facility. This includes treatment for both mental disorders and substance use disorder (SUD).  

Drug testing

If your provider recommends drug testing that’s medically necessary, you’re covered for that, too. 

Hospital stays

You’re covered if you need to stay in the hospital for behavioral health issues or SUD. 

Inpatient psychiatric care 

Members who are: 

•  Under age 21: are covered if they need to stay in a facility for a psychiatric condition. This includes treatment through what’s called an individual plan of care. 
• Between age 21 and 64: are covered for full-time psychiatric care. This includes treatment through an individual plan of care from an Institution for Mental Diseases (IMD).  

 

Outpatient services

Members with mental illness and SUD are covered for: 

• Outpatient treatment (services you get when you’re not staying at a hospital or care facility)
• Assertive community treatment (ACT) (age 18 and up)  

 

Psychological therapy

Members are covered for counseling (or therapy) visits with a psychologist. This includes: 

• Evaluation and treatment 
• Individual, family and group therapies 
• Telehealth sessions

 

Substance use disorder (SUD) services

Members with SUD are covered for:  

• Targeted care management
• Physician-supervised medication 
• Counseling services

Members with mental health disorders and substance use disorder (SUD) are covered for services that may include:

• Evaluation
• Referral
• Diagnosis
• Therapeutic care
• Crisis intervention 

 

Members with autism spectrum disorder are covered for applied behavior analysis (ABA).

Psychiatric residential and rehabilitation facilities

You’re covered if your child needs to stay in a treatment facility. This includes treatment for both mental health disorders and substance use disorder (SUD).  

Drug testing

If your provider recommends drug testing that’s medically necessary, you’re covered for that, too.

Hospital stays

You’re covered if you need to stay in the hospital for behavioral health issues or SUD.

Inpatient psychiatric care (under age 21)

Your child is covered if they need to stay in a facility for a psychiatric condition. This includes treatment through what’s called an individual plan of care. 

Outpatient services

Members with mental illness and SUD are covered for:

• Outpatient treatment (services you get when you’re not staying at a hospital or care facility)
• Assertive community treatment (ACT) (age 18 and up) 

 

Psychological therapy

You’re covered for counseling (therapy) visits with a psychologist. This includes:

• Evaluation and treatment 
• Individual, family, and group therapies
• Telehealth sessions

 

SUD services

Members with SUD are covered for:

• Targeted care management
• Physician-supervised medication
• Counseling services