Insurers are required to give you information in answering questions 1 through 7. 

1. What are the steps that must be taken to have mental health services paid for by my plan?

• Direct self referral

• Primary care provider referral required

• Pre-authorization phone 

2. What information about my mental condition will anyone other than my mental health provider see?

• no information, other than your diagnosis

• brief summary of emotional difficulties

• complete description of treatment

1. Do I have to pay more than the co-pay, deductible and other charges for my other covered medical services to get mental health services under this plan?

	Same	Less	More
Deductibles
Co-pays

4. What is the maximum number of medically necessary in-patient days and out-patient visits I can get each year under this plan?

	Inpatient	Outpatient
Less than 10
11 to 15
16 to 20
21 to 30
Unlimited

5. What is the average number of outpatient visits this plan pays for per person seeking these services?

• Less than 5
• 5 to 10
• 10 to 20
• 20+

6. In which of the following circumstances where I might need mental health services would I find them excluded or subject to restrictions or limitations other than medical necessity?

• Psychological testing
• Mental disorder with a physical basis such as Tourette's Syndrome
• Court ordered treatment
• Self inflicted harm (suicide attempt)
• Learning disorders
• Eating disorders
• Sexual dysfunction
• Couples therapy
• Marriage therapy
• Child therapy
• Institutional care

7. How soon after requesting mental heath treatment should I expect to receive my first treatment visit in non-emergency circumstances?

• No more than 72 hours
• No more than 7 days
• More than 7 days