Behavioral Health Plan Benefits
Your MHN behavioral health plan benefits may include both mental health and substance use disorder benefits, such as:
- Outpatient assessment and treatment with counselors, psychiatrists or psychologists
- Inpatient assessment and treatment
- Alternative levels of care, including partial hospitalization, intensive outpatient and residential treatment programs
MHN does not provide or administer prescription drug or pharmacy benefits. Please consult your medical plan documents or your medical plan's website (Health Net members, click here) for information about your prescription drug coverage.
Medi-Cal mental health benefits available through MHN are more limited (see Expanded Mental Health Benefits under Medi-Cal below).
Outpatient office visits generally do not require preauthorization. However, some benefits are only paid if they are preauthorized. You can also see a summary of MHN's clinical philosophy, and for information on MHN's processes for reviewing, authorizing, approving, modifying or denying requests for services.
This is only a summary of benefits. For details about copayments, deductibles, exclusions and member/dependent eligibility, please refer to your plan documents, or contact MHN or your benefits manager.
(Covered California, Cover Oregon, Health Insurance Marketplace in Arizona)
If you are enrolled in a Health Net health plan through the Exchanges, behavioral health benefits available through MHN include the mental health and substance use disorder benefits listed above. All mental health and substance use disorder benefits are considered Essential Health Benefits. Please review your Health Net policy/plan documents for details regarding your behavioral health plan benefits and any special rules and/or rights available to individuals and families enrolled through the Exchange.
As of January 1, 2014, if you are enrolled in a Health Net Medi-Cal plan, behavioral health benefits available through MHN include:
- Individual and group mental health evaluation and treatment (psychotherapy)
- Psychological testing to evaluate a mental health condition
- Outpatient services that include laboratory work, medications and supplies
- Outpatient services for the purposes of monitoring medication therapy
- Psychiatric consultation
If you are receiving or are eligible to receive county mental health specialty services, the expanded mental health benefits noted above are excluded, and the county is responsible for providing the services. Substance use disorder benefits are also the responsibility of the county.
If you think you need help with a mental health or substance use issue, just call the toll-free number listed on your ID card, or call (888) 327-0010. Behavioral health customer service representatives are standing by 24/7 to take your call. We will:
- Answer any questions you have about your behavioral health/substance use benefits
- Assess your referral needs over the telephone
- Provide crisis intervention if needed; or
- Help you secure an appointment (within 48 hours if urgent or, if not urgent, within 10 business days)
If you choose a practitioner while on the call, the intake specialist can authorize the initial sessions on the phone. If you need time to choose the right counselor, you can call us back for authorization when you decide who you want to see.
If you choose a provider while on the call, the customer service representative can authorize the initial sessions on the phone. If you need time to make your choice, you can call us back for authorization when you?re ready. You can find a network provider by calling MHN or by using our fast and convenient online provider search.
There are many compelling reasons to choose an MHN network provider, including this: your out-of-pocket costs are almost always lower. Click here to learn more about filing claims.
If you, or a covered family member, are currently receiving mental health services or substance abuse disorder treatment, inpatient or outpatient, through your previous health plan, please call MHN as soon as possible at the number listed on your ID card or at 1-888-327-0010. If your current provider is not an MHN network provider, we will connect you with a care manager who will carefully review your situation and arrange for medically appropriate transition of your care to an MHN participating provider.
When you lose your insurance because you?ve lost your job or had your hours reduced, make sure you explore your options for continuation coverage.
Federal COBRA is a U.S. law that applies to employers and group health plans that cover 20 or more employees. It lets you keep your group health insurance when your job ends or your hours are cut. You have to pay the premium but you can keep your insurance for at least 18 months. To learn more about COBRA, contact your employer or visit the U.S. Department of Labor website.
Cal-COBRA is a California law that is like Federal COBRA. Cal-COBRA applies to employers and group health plans that cover from 2 to 19 employees. It lets you keep your insurance for up to a total of 36 months.
Cal-COBRA is also for people who use up their Federal COBRA. When your 18 months of Federal COBRA ends, you can buy 18 more months of health insurance under Cal-COBRA.
To qualify, you must not be eligible for other group medical coverage or entitled to Medicare. If you think you may be eligible, please contact MHN via your current access number. If you don?t have this information, please contact your former employer to obtain it, or complete and mail in the Cal-COBRA Enrollment Request form (PDF) to the following address:
Attn: Membership Accounting ? Cal-COBRA
P.O. Box 550
Rancho Cordova, CA 95741
MHN associates who make care management determinations are never provided compensation based on volume of adverse determinations, reduction or limitation on patient lengths of stay, benefits, services or charges, and/or the frequency of telephone of other business contacts with health care providers of patients.
Also, performance standards are not set based on any of these things, and employment is not conditioned upon them.
Any associate of MHN who makes care management determinations will not do so in any case where they have a conflict of interest as defined by MHN policy.
(Applicable to members who receive APTC-Advance Premium Tax Credit)
Premiums for each billing period are due on the first day of the month. If you do not pay your premiums on time, you are at risk of having your coverage suspended and/or terminated. You have a 3-month grace period after your premium due date to pay your premium in full. If Health Net does not have ALL premium amounts due through the grace period by the last day of the grace period (end of month 3), your coverage will be terminated as of the 1st of the month following month 1 of the grace period.