Inpatient /
Alternative Care |
100% of HMC authorized network charges for authorized
inpatient treatment up to 45 days per person per calendar
year. Lifetime maximum of 90 days of Inpatient treatment.
2 days of Residential or Partial treatment equal 1 day
of inpatient treatment. |
50% of UCR charges for HMC authorized treatment for up
to 45 combined days per person per calendar year with a
combined lifetime maximum of 90 days of Inpatient and Alternate
Care. |
Outpatient
|
100%, of HMC authorized Individual/Group
Outpatient Sessions after co-pay. Maximum of 50 sessions
per eligible per calendar year. |
50% of UCR charges for HMC authorized treatment for up
to 50 treatment sessions per person per calendar year. |
|
INDIVIDUAL SESSIONS
1-20 Sessions $10 co-pay
21-50 Sessions $15 co-pay |
GROUP SESSIONS
1-20 Sessions $5 co-pay
21-50 Sessions $4.50 co-pay |
|
| |
100% of HMC authorized Network charges up to $10,000 per
episode with a 2- episodes lifetime maximum. |
50% of UCR charges for HMC authorized inpatient/alternate
care treatment up to $10,000 per episode with a 2-episodes
lifetime maximum. |
