Page 101 - Aegion PPO SPDs
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Mental Health Parity and Addiction Equity Act
The Mental Health Parity and Addiction Equity Act provides for parity in the application of aggregate
treatment limitations (day or visit limits) on mental health and Substance Abuse benefits with day/visit limits
on medical/surgical benefits. In general, Group Health Plans offering mental health and Substance Abuse
benefits cannot set day/visit limits on mental health or Substance Abuse benefits that are lower than any
such day/visit limits for medical and surgical benefits. A plan that does not impose day/visit limits on medical
and surgical benefits may not impose such day/visit limits on mental health and Substance Abuse benefits
offered under the plan. Also, the Plan may not impose Deductibles, Coinsurance and out of pocket
expenses on mental health and Substance Abuse benefits that is more restrictive than Deductibles,
Coinsurance and out of pocket expenses applicable to other medical and surgical benefits. Medical
Necessity criteria are available upon request.
Special Enrollment Notice
If You are declining enrollment for yourself or Your Dependents (including Your Spouse) because of other
health insurance coverage, You may in the future be able to enroll yourself or Your Dependents in this Plan
if You or Your Dependents lose eligibility for that other coverage (or if the employer stops contributing
towards Your or Your Dependents’ other coverage). However, You must request enrollment within 30 days
after Your or Your Dependents’ other coverage ends (or after the employer stops contributing toward the
other coverage).
In addition, if You have a new dependent as a result of marriage, birth, adoption, or placement for adoption,
You may be able to enroll yourself and Your dependents. However, You must request enrollment within 30
days after the marriage, birth, adoption, or placement for adoption.
Eligible Employees and Dependents may also enroll under two additional circumstances:
the Employee’s or Dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is
terminated as a result of loss of eligibility; or
the Employee or Dependent becomes eligible for a subsidy (state premium assistance program)
The Employee or Dependent must request Special Enrollment within 60 days of the loss of Medicaid/CHIP
or of the eligibility determination.
To request special enrollment or obtain more information, call the Member Services telephone number on
Your Identification Card, or contact Your Plan Administrator.
101
The Mental Health Parity and Addiction Equity Act provides for parity in the application of aggregate
treatment limitations (day or visit limits) on mental health and Substance Abuse benefits with day/visit limits
on medical/surgical benefits. In general, Group Health Plans offering mental health and Substance Abuse
benefits cannot set day/visit limits on mental health or Substance Abuse benefits that are lower than any
such day/visit limits for medical and surgical benefits. A plan that does not impose day/visit limits on medical
and surgical benefits may not impose such day/visit limits on mental health and Substance Abuse benefits
offered under the plan. Also, the Plan may not impose Deductibles, Coinsurance and out of pocket
expenses on mental health and Substance Abuse benefits that is more restrictive than Deductibles,
Coinsurance and out of pocket expenses applicable to other medical and surgical benefits. Medical
Necessity criteria are available upon request.
Special Enrollment Notice
If You are declining enrollment for yourself or Your Dependents (including Your Spouse) because of other
health insurance coverage, You may in the future be able to enroll yourself or Your Dependents in this Plan
if You or Your Dependents lose eligibility for that other coverage (or if the employer stops contributing
towards Your or Your Dependents’ other coverage). However, You must request enrollment within 30 days
after Your or Your Dependents’ other coverage ends (or after the employer stops contributing toward the
other coverage).
In addition, if You have a new dependent as a result of marriage, birth, adoption, or placement for adoption,
You may be able to enroll yourself and Your dependents. However, You must request enrollment within 30
days after the marriage, birth, adoption, or placement for adoption.
Eligible Employees and Dependents may also enroll under two additional circumstances:
the Employee’s or Dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is
terminated as a result of loss of eligibility; or
the Employee or Dependent becomes eligible for a subsidy (state premium assistance program)
The Employee or Dependent must request Special Enrollment within 60 days of the loss of Medicaid/CHIP
or of the eligibility determination.
To request special enrollment or obtain more information, call the Member Services telephone number on
Your Identification Card, or contact Your Plan Administrator.
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