Allied Trades Assistance Program

If you have mental health, behavioral health, or substance abuse needs

Mental/Behavioral health outpatient services

$20 copay per visit

70% of allowance, after deductible *

Out of pocket maximum

Mental/Behavioral health partial services

$20 copay per day

70% of allowance, after deductible *

Out of pocket maximum

Mental/Behavioral health inpatient services

$100 copay per day for the first (5) days

70% of allowance, after deductible *

$500 maximum copay per individual per stay

Mental/Behavioral health inpatient miscellaneous facility charges

Included in room and board facility charges

70% of allowance, after deductible *

Out of pocket maximum

Substance use disorder outpatient services

$20 copay per visit

70% of allowance, after deductible *

Out of pocket maximum

Substance use disorder partial services

$20 copay per day

70% of allowance, after deductible *

Out of pocket maximum

Substance use disorder inpatient services

$100 copay per day for the first (5) days

70% of allowance, after deductible *

$500 maximum copay per individual per stay

Substance use disorder miscellaneous facility charges

Included in room and board facility charges

70% of allowance, after deductible *

Out of pocket maximum

What is the plan year?

The plan year is a calendar year, January 1 – December 31.

The plan year impacts the way your benefit plan will cover your treatment costs.

What is the overall deductible?

For each calendar year:
Network: Individual $0/ Family $0.
Out of Network: Individual $500/ Family $1000

You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use.

Is there an overall annual limit on what the plan pays?

Yes.
Network: Not applicable
Out of Network: $2,000,000

This plan will pay for covered services only up to this annual limit during each coverage period, even if your own need is greater. You are responsible for all expenses above this limit.

Is there an out of pocket maximum on my expenses?

Yes.
Network: Not applicable
Out of Network: Individual $3000/ Family $6000

The out of pocket maximum is the most you could pay during a coverage period for your share of the cost of covered services. This limit helps you plan for health care expenses.

Is there a limit on the number of hospital days covered by this plan?

Network: unlimited (365 per year)
Out of network: 70 days per plan year

The number of out of network days allowed by this plan is a maximum of 70 per plan year. This means there is only out of network coverage for 70 days or less per plan year. Additional days will not be covered by this plan.

Does this plan use a network of providers?

Yes. For a list of network providers, see www.alliedtrades-online.com or call 1-800-258-6376

If you use an in network provider, this plan will pay some or all of the costs of covered services. Be aware, your in network doctor or hospital may use an out of network provider for some services. Plans use the term in network, preferred, or participating for providers in the network.

Do I need authorization/precertification to see a Mental/Behavioral health or Substance use provider?

Yes.

Authorization is required for all Mental/Behavioral health and Substance use treatment services. Authorization can be obtained by calling ATAP at 1-800-258-6376. (Typically, the provider calls for this information). Failure to pre-authorize treatment will result in a $1000 penalty.

What is the effective date of the policy?

SPDs are effective the 1st of each year & benefits are based on a calendar year

N/A

Is there any pre-existing?

No

N/A

Are the mental health and substance abuse benefits combined?

No

N/A

Is accreditation required?

Yes

Both state license and JACHO accreditation are required

Are prescriptions covered by this plan?

No

Prescription medications are covered by the client’s prescription plan

Do intensive outpatient programs and partial hospitalization programs come from the inpatient or outpatient benefit?

Outpatient

N/A

What type of plan is this (PPO, HMO, etc.)?

Self funded

N/A

Are all levels of care authorized based on medical necessity?

Yes

N/A

Where do providers send claims?

Claims address will be provided when pre-certification is requested

Eligibility and potential benefit term date will also be explained at this time. Provider can call 800-258-6376 at the time of pre-certification to obtain this information

Is there an electronic payer ID?

Not at this time

N/A

Are there any limitations on this policy?

Yes

See above SPD for information about deductibles, out-of-pocket maximums, and other benefit limitations