Mental Health Benefits: Understanding Coverage for Therapy Treatment

Included in the wide range of benefits provided by the Health Plan is coverage for mental health services, including individual therapy. Individual therapy is covered when medically necessary. However, family therapy is not covered by the Health Plan. Knowing the differences between individual and family therapy can help you anticipate which services will be covered by the Health Plan.

Family and Relationship Therapy

The Health Plan considers a therapy session to be “family therapy” when another family member is present during a session. For example, if a child is receiving therapy and the child’s parents and/or siblings are included in a therapy session, that session is considered family therapy, and will not be covered.

Relationship, marriage counseling and couples therapy are also not covered by the Health Plan. If the Health Plan receives records indicating the presence of multiple parties in one therapy session, those sessions will not be covered, even if they were billed as individual therapy.

Individual Therapy

As noted above, individual therapy is covered by the Health Plan when treatment is medically necessary (See sidebar on page 5: How does the Health Plan determine medical necessity?). Medically necessary individual therapy sessions are subject to the same deductible and co-insurance as other covered medical services.

If you are in doubt as to whether a mental health therapy service will be covered under the Health Plan, contact Participant Services at (877) 866-2200, Ext. 401.