EAP & Mental Health Plan Changes | Health Care Benefits

 

GOLD COAST JOINT BENEFITS TRUST IMPORTANT CHANGES TO THE EAP FOR ELIGIBLE GOLD  COAST JOINT BENEFIT TRUST MEMBERS, AND CHANGES TO MENTAL HEALTH/SUBSTANCE ABUSE BENEFITS FOR PPO MEMBERS

The Board of Directors is pleased to announce that effective January 1, 2018, the Gold Coast
Joint Benefit Trust is making two important changes, to enhance the EAP and the PPO mental
health/substance abuse benefits. Please read this information carefully.

the forms/mailings that explain this are here:

EAP Change

Effective January 1, 2018, the Trust will provide EAP services through Anthem BlueCross to
eligible PPO and Kaiser participants. The attached Service Summary provides an overview of
the many services available to you, including up to five in-person counseling visits for each
personal situation at no charge. To access these benefits call Anthem at 1-800-999-7222 or go
online by following the instructions at the bottom of the enclosed Service Summary. Services
are not available through Optum after January 1.

Improved PPO Mental Health/Substance Abuse Treatment Benefits

Benefits for mental health/substance abuse treatment under the PPO plan have been improved.
Inpatient and outpatient benefits obtained on or after January 1, 2018 will be paid on the same
basis as other medical care – subject to the same deductible and copays and without annual or
lifetime limits on the number of days or outpatient visits. Just like other medical benefits, mental
health/substance abuse services must meet the Trust’s definition of Medical Necessity in order to
be paid. In order for you to maximize your benefits, always use Anthem PPO providers, and get
preauthorization from Anthem for inpatient mental health/substance abuse treatment. To find
PPO providers, log on to Anthem.com, https://www.anthem.com/ca/health-insurance/providerdirectory.

To obtain preauthorization for inpatient treatment, call 1-800-274-7767.

PPO Mental Health/Substance Abuse Benefits

Effective January 1, 2018

Deductible$400 per person, $1,200 per family. Applies to covered medical services
and mental health/substance abuse benefits combined.
 
PPONon-PPO
Annual Out-of-Pocket
Maximum
$2,000 per person
$4,000 per family
No maximum
Outpatient Visits90% of PPO charges after
deductible is met
50% of UCR after deductible is
met
Inpatient (Pre-Authorization
from Anthem required)
90% of PPO charges after
deductible is met
50% of UCR after deductible is
met
FREQUENTLY ASKED QUESTIONS

I’m a Kaiser member. Have my mental health/substance abuse benefits through Kaiser
changed?
No. If you need mental health/substance abuse treatment through Kaiser beyond what’s offered
through the EAP or if you’d rather not use the EAP and you prefer to access care through Kaiser
only, you can still call Kaiser any time 24/7 at 1-800-900-3277 (TTY 711). You do NOT need a
referral from your personal doctor to see a therapist. For more information on Kaiser’s mental
health/substance abuse treatment programs you can also visit
https://healthy.kaiserpermanente.org/southern-california/doctors-locations/how-to-findcare/
behavioral-health

Can I go to any provider I want, for my free EAP counseling visits?
No. For those visits to be covered you need to go through the EAP; call 1-800-999-7222.

I liked the provider I saw through Optum previously. Is he available through Anthem?
Most of the Optum providers used last year by Gold Coast participants are on the Anthem
network, but not all of them. To find out whether the provider is part of the Anthem PPO, call
the EAP at 1-800 999-7222, check online at Anthem.com or ask the provider directly.

I’m a PPO member and I’m seeking mental health (or substance abuse) treatment beyond
what’s offered through the EAP. I found a provider I like but she isn’t with the PPO. Can I
still see her?
Yes, but be advised that the non-PPO benefits apply so you’ll probably have to pay more out-of-pocket than if you use a PPO provider.

I’m a PPO member. If a provider I like is not in Anthem’s network, can he join?
Yes, if he meets Anthem’s standards and agrees to Anthem’s reimbursement rate. Note that not
all providers want to be in PPOs. It sometimes helps if patients encourage their provider to join
the PPO.
In the PPO, do I need pre-authorization to see an outpatient mental health or substance abuse provider?
No. The preauthorization requirement only applies to inpatient services.

What is my copay for use of the EAP?
The EAP is free to eligible employees, covered dependents and anyone who resides in the
employee’s household whether they have Kaiser or the PPO as their medical plan.

Under the PPO, is mental health/substance abuse treatment subject to the deductible?
Yes. There is a deductible of $400 per individual, $1,200 per family that applies to all covered
medical services, which now also includes mental health/substance abuse treatment. There is no
separate deductible for mental health/substance abuse treatment. In other words, you can meet
the deductible by seeing medical providers, mental health providers, or any combination of the
two.

When I use PPO mental health/substance abuse providers do my out-of-pocket costs count
toward my annual out-of-pocket maximum?
Yes.

When can I start accessing the new EAP?
On or after January 1, 2018.
Will I be getting more information about the new program? What happens next?
Absolutely! In December you’ll be receiving a new ID card which will include in the EAP phone
number, and you’ll be seeing more information on the EAP services available in various Trust
communications and at your work site.

And if I have questions between now and January 1?
Call the Trust Fund office at 1-800-556-5918 or Anthem EAP at 1-800-999-7222.
The Gold Coast Directors and the Trust’s medical providers, Anthem and Kaiser, know your
emotional wellbeing is important and are committed to helping you be mentally, physically and
emotionally healthy. You and your covered dependents are urged to take advantage of the
resources offered.

 

Employee Assistance Program
Service Summary

For program limitations and exclusions contact your EAPs toll-free number.
Confidentiality: No one will know you’ve called EAP unless you give them permission in writing in accordance with federal and state law, and professional ethical standards.

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol
are registered marks of the Blue Cross Association.

The Anthem Employee Assistance Program (EAP) provides solutions to help you balance
work and life through confidential and easily accessible services. Anthem EAP puts
convenient resources within your reach, and that helps you – and your household
members – stay healthy. Anthem EAP services include:

Face-to-Face Counseling. You and your household
members are eligible for up to 5 visits for each personal
situation, as needed. You don’t have to have Anthem
insurance to qualify for this benefit. You can simply call
the toll-free Anthem EAP number or access services
online using the “Member Center.”

Legal Assistance. You can receive a free 30 minute
consultation in person or over the phone at a time that is
convenient for you. You can even receive a discount on
fees should you retain the attorney. Online resources
include free legal forms, seminars and a full library of
articles.

Financial Assistance. Our financial professionals
provide free telephonic consultation on the financial
topics that are important to you. Counseling sessions
have no time limitations, and are available without
appointment during regular business hours. Online
resources include an assortment of financial calculators
and access to PocketSmith, a budgeting and
management tool.

ID Recovery. Specialists are available 24/7 to assess
your risk level and then identify steps to resolve
potential identity theft. All services are provided to you
free of charge. This may include completing any
necessary paperwork, reporting to the consumer credit
agencies, and negotiating with creditors to repair debt
history. Our specialists will work with you to restore your
financial identity to its pre-theft status.

Crisis Consultation. If you have an emergency, simply
call the Anthem toll-free number. Consultants are
available 24/7/365 to help or just listen, depending on
your needs.

myStrength. This online and mobile “health club for your
mind” gives you information based on the latest research to
help you and your household members handle stress and
other issues. This tool includes online learning modules,
mood trackers, videos, articles and inspirations to support
you in developing a personal action plan and make healthy
changes.

Tobacco Cessation (Online and Coaching)
Online Program: LivingFree™ is a free 10 sessions,
online training program which will help you learn how to
break the tobacco habit. The program focuses on the
root emotional and physical causes of using tobacco.
Telephonic Coaching: A free service provided via
telephone or through instant messaging. The certified
Coach will help you address the triggers of your
tobacco use and how to overcome them as well as
address issues related to weight management and
fitness.

Dependent Care and Daily Living Resources. You and
your household members can get information on child care,
adoption, summer camps, college placement relocation,
plus resources on elder care issues and assisted living by
accessing the website’s resources or by calling the EAPs
toll-free number and speaking with a work/life
representative.

Other Web Resources. Full library of health and emotional
well-being articles. Monthly webinars. Self-assessment
tools on topics such as depression, relationships, anxiety,
anger, alcohol, eating and more.
To contact Anthem EAP, please call us toll-free at 800 999-7222
or visit us at www.anthemeap.com.
Enter your company code: Gold Coast Joint Benefits Trust