Page 10 - 2016 Benefit Booklet AYN
P. 10

Page 10


                           Medical Benefits cont’d



                                                                 Member Responsibility

                                         Benefit           In-Network          Non-Network
                                  Mental Health &
                                     Substance Abuse:
                                  Office Visit          Deductible then 50%   Deductible then 60%
                                  Inpatient/Outpatient-30   Deductible then 50%   Deductible then 60%
                                  visits per year

                                     These illnesses are not subject to any of the above durational limits: Bipolar
                                  Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder, Paranoid and
                                   Other Psychotic Disorder, Schizoaffective Disorder, Schizophrenia, Post-traumatic
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