MySLC

Guide to Understanding Your Mental Health Coverage

1. Access a copy of your Health Insurance card
2. Call the Member Services phone number on the back of your card.
   1. Information you may need to provide to Member Services:
      1. Your name, date of birth, insurance ID number
      2. The primary card holder’s name, date of birth, insurance ID number

Questions to ask Member Services:

3. Is my coverage active?
4. Do I have mental health coverage (sometimes also called behavioral health coverage).
5. Do I have In-network* coverage?
   1. Ask for the details of your In-network coverage:
      1. Percent or dollar amount that insurance pays per session?
      2. Percent or dollar amount that patient pays per session?
      3. Deductible*** to be met before reimbursement occurs?
6. Do I have Out-of-Network** coverage?
   1. Ask for details of your Out-of-network coverage:
      1. Percent or dollar amount that insurance reimburses patient per session?
      2. Percent or dollar amount that patient pays per session?
      3. Deductible*** to be met before reimbursement occurs?
7. Can the insurance company send you a list of in-network providers within a 5 mile radius of zip code 10708?  (The SLC Health & Wellness Center can review the list with you)
8. How do I submit receipts for reimbursement?
9. Where can I find claim forms on the insurance website?

Definitions:

*In-network:  In network refers to providers or health care facilities that are part of a health plan's network of providers with which it has negotiated a discount.

**Out-of-network:  refers to physicians, hospitals or other healthcare providers who do not participate in an insurer's provider network. This means that the provider has not signed a contract agreeing to accept the insurer's negotiated prices.

***Deductible:  a specified amount of money that you must pay before an insurance company will pay a claim.