Mental Health Plan

General Info

All employees enrolled in SVUSD's HMO or PPO plans are also enrolled in mental health coverage at no additional cost. Mental health benefits are provided through Optum Behavioral Health, of the nation's leading behavioral health care organizations. Services include outpatient mental health visits, inpatient mental health, outpatient chemical dependency, inpatient chemical dependency, and serious mental illness care.

Please note: these benefits are provided through Optum, NOT Blue Shield. Please refer to the "Contact" tab below for information related to billing, customer service, and network.

Employee Assistance Program (EAP)

All SVUSD employees and their families, regardless or their benefit eligibility, may utilize the Employee Assistance Program through Optum. The EAP can provide short-term counseling or referrals for additional care for a variety of topics, including:

      • Depression, stress, anxiety
      • Relationship difficulties
      • Substance abuse
      • Dealing with domestic violence
      • Eating disorders
      • Balancing work and life issues

Employees may be eligible to receive counseling services under the EAP at no cost. To utilize this benefit, please contact Optum using the information on the "Contact" tab below.

Contact

Employees can browse the directory of providers, as well as other mental health articles and tools, by visiting the Optum website, access code SVUSD. For additional assistance, customer service can be reached by calling 800-234-5465.

Please be advised Optum does not provide SVUSD employees with an ID card. When asked, employees should instruct Optum or their provider of their Optum coverage through SVUSD. Additionally, employees may provide their social security number as an additional method to verify coverage.

Below are summaries of the benefits and coverages for the various mental health plans. Accessible Alternative Version (AAV) of the available medical plans can be viewed utilizing the accordion navigation below.

Summary of Benefits

PPO

Certain mental health services require pre-certification. To access benefits, please call 800-234-5464.

Employee Assistance Program (EAP):

Network TreatmentNon-Network Treatment
3 visits per problem per year covered 100%Not Covered

Mental Health and Substance Abuse Benefits:

BenefitNetwork TreatmentNon-Network Treatment
DeductibleNoneNone
Out of Pocket Maximum

$1,000 EE

$3,000 EE + family

$5,000 EE

$15,000 EE + family

Outpatient Office VisitsPlan pays 100% of network charges after $20 copayPlan pays 60% of UCR charges after deductible
Outpatient Other/Intensive OutpatientPlan pays 100% of network chargesPlan pays 60% of UCR charges after deductible
Inpatient and Alternate Levels of CarePlan pays 100% of network chargesPlan pays 60% of UCR charges
Annual MaximumsNoneNone
Lifetime MaximumsNoneNone

Non-Network claims must be submitted within 1 year from the date of service. Claim forms may be obtained online at: www.liveandworkwell.com. Access code: svusd. Claims must be submitted to: OptumHealth Claims, P.O. Box 30602, Salt Lake City, UT 84130-0602

Please note:

  • Pre-certification required for EAP services and certain in-network mental health services.
  • Pre-Certification required for certain non-routine outpatient and all inpatient non-network mental health services. Failure to obtain required certification will result in a $350 penalty subject to retrospective review for medical necessity. Member may be billed by provider or facility for balance over and above amount paid by benefits.
  • Copayments for in-network services apply to both in-network and non-network out-of-pocket maximums (one-way). Out-of-pocket maximum cross accumulates with Blue Shield of California.
  • Copay applies to out of pocket maximum.
  • Effective 7/1/2012, ABA and Enhanced Autism services are now covered per the CA State Mandate on Autism Coverage. All claims with autism diagnoses 299.00, 299.80, 299.10, and 299.90 will be covered when using procedure codes of H0031, H0032, H2012, H2019, H20.

HMO

Certain mental health services require pre-certification. To access benefits, please call 800-234-5465.

Employee Assistance Program (EAP):
Network TreatmentNon-Network Treatment
3 visits per problem per year covered 100%Not covered
Mental Health and Substance Abuse Benefits:
BenefitNetwork TreatmentNon-Network Treatment
DeductibleNoneNone
Out of Pocket Maximum

$1,000 EE

$2,000 EE + Family

$1,000 EE

$2,000 EE + Family

Outpatient Office VisitsPlan pays 100% of network charges after $5 copayPlan pays 60% of UCR charges after deductible
Outpatient Other/Intensive OutpatientPlan pays 100% of network chargesPlan pays 60% of UCR charges after deductible
Inpatient and Alternate Levels of CarePlan pays 100% of network chargesPlan pays 60% of UCR charges
Annual MaximumsNoneNone
Lifetime MaximumsNoneNone

Non-Network claims must be submitted within 1 year from the date of service. Claim forms may be obtained online at: www.liveandworkwell.com. Access code: svusd. Claims must be submitted to: OptumHealth Claims, P.O. Box 30602, Salt Lake City, UT 84130-0602

Please note:

  • Pre-certification required for EAP services and certain in-network mental health services.
  • Pre-Certification required for certain non-routine outpatient and all inpatient non-network mental health services. Failure to obtain required certification will result in a $350 penalty subject to retrospective review for medical necessity. Member may be billed by provider or facility for balance over and above amount paid by benefits.
  • Copayments for in-network services apply to both in-network and non-network out-of-pocket maximums (one-way). Out-of-pocket maximum cross accumulates with Blue Shield of California.
  • Copay applies to out of pocket maximum.
  • Effective 7/1/2012, ABA and Enhanced Autism services are now covered per the CA State Mandate on Autism Coverage. All claims with autism diagnoses 299.00, 299.80, 299.10, and 299.90 will be covered when using procedure codes of H0031, H0032, H2012, H2019, H20.