Understanding Your Employee Assistance Program (EAP) & Behavioral Health Benefits

June 10, 2008

Attention MCSIG Members:

Effective July 1, 2008, we are implementing a new benefit plan design for MCSIG’s behavioral health program currently administered through PacifiCare Behavioral Health (PBH), A United HealthCare Company. This is a new benefit design that will be replacing the current benefit plan design (see Schedule of Benefits on the reverse side of this letter). Under this new benefit design, you and your covered dependents will now have access to both in-network and out-of-network benefits – this is an enhancement to your benefits design however costs associated with services vary and depend on your providers’ in or out-of-network status.  Please note, your current EAP (Employee Assistance Program) benefits are not affected and will not be changing. 

1. What are the new benefits?

The new benefits are outlined on the Schedule of Benefits on the reverse side of this letter.

2. When will my new benefits be effective?  When will they renew?

MCSIG benefits are on a Calendar Year basis meaning the plan benefits renew every January 1^st.  Since this new plan design will take effect 7/1/08, your new benefits will be effective at that time.  On January 1, 2009, your benefits will renew again because it is the beginning of a calendar year, however, they will not renew again until the next Calendar Year (January 1, 2010).  Therefore, this year only the new benefits will take effect on 7/1/08 (outside the Calendar Year). 

3. What is the difference between In-Network & Out-of-Network Benefits and how do I access each? 

In-Network means that the provider (therapist, psychiatrist, or facility) is on the PacifiCare Behavioral Health, A United HealthCare Company’s Panel.  Out-of-Network means the provider is not on the PacifiCare Behavioral Health panel of providers.  You can check if your provider is In-Network or Out-of-Network by calling PacifiCare Behavioral Health, A United HealthCare Company, directly @ 1-800-999-9585 or logging on to the website @ www.pbhi.com.

Login: MCSIG

Password: care

 4. How can I find and submit claim forms?

You can access claim forms online via pbhi.com. 

5. What if I am currently treating with a non-preferred provider?

If you are currently treating with a non-preferred provider, please contact PacifiCare Behavioral Health (phone number below).