MENTAL HEALTH AND CHEMICAL DEPENDENCY BENEFITS Mental Health & Chemical Dependency Benefit Modifications Effective 1/1/2008

Mental health and chemical dependency benefits are provided through ValueOptions. ValueOptions has contracted with a comprehensive nationwide network of professionals, which includes psychiatrists, psychologists, clinical social workers, marriage, family and child counselors, treatment programs, hospitals and other clinical providers. Benefits are available only through providers in the ValueOptions network and authorization by ValueOptions is required for all care. Medicare-prime participants accessing care through ValueOptions are required to use Medicare Approved Providers.

Privacy and confidentiality are basic rights of any individual who seeks counseling. ValueOptions is dedicated to protecting your privacy, and all services are held confidential in accordance with state and federal laws.

Eligibility
Plan I
Plan I Earned, Self-Pay and Senior Performer participants and their eligible dependents are eligible for the ValueOptions Program only if this Plan is their primary Plan or if Medicare is their primary plan and this Plan is their secondary plan.

Plan II
Plan II Earned and Self-Pay participants who have a minimum of three years of Earned Eligibility and their eligible dependents are eligible for the ValueOptions Program only if this Plan is their primary Plan or if Medicare is their primary plan and this Plan is their secondary plan. All Earned Health Plan years, including the years you chose not to pay the premium, will count toward the three year requirement.

Participants in the Lower Cost Self-Pay Plan are not eligible for this benefit.

Benefits Available
The purpose of the program is to provide short-term, goal-focused treatment. The program includes a wide range of services including outpatient day treatment, home care and residential rehabilitation for chemical dependency. The charts on the next page detail the benefits available and the amount the Plan will cover.

Smoking cessation programs, weight loss programs and legal and financial counseling are not covered.

How to Obtain Benefits
The first step in any successful behavioral change is the decision to seek help. Once you decide to seek help, you may call ValueOptions 24 hours a day, seven days a week. An experienced mental health professional will answer your questions and guide you in selecting a network provider who specializes in addressing your specific issues. ValueOptions will also take into account your proximity to the provider’s location, as well as the after-care system available to you when suggesting providers. All calls are strictly confidential in accordance with state and federal laws. You will be asked to make an appointment convenient with your schedule directly with the provider within 24 hours.

For authorization and/or network provider information:
Toll-free: (866) 277-5383
Hearing impaired: (800) 477-4624
Web site: www.valueoptions.com/sagph

After the initial visit, a mental health professional will assess your needs and support you by coordinating and clarifying your treatment plan with you and the network provider. If you are not fully satisfied after your initial visit with the recommended
provider, call the ValueOptions number. The staff will arrange a visit with a different provider.

MENTAL HEALTH TREATMENT BENEFITS


Outpatient Counseling Services

Inpatient Care Services

	Plan Payment	Your Co-payment	Maximums
Plan I	100% of contracted charges	$0	60 days per calendar year
Plan II	100% of contracted charges	$0	30 days per calendar year

If your eligibility changes from Plan I to Plan II during a calendar year, any visits or days that were applied toward your annual maximums under Plan I will apply toward your Plan II annual maximums. If your eligibility changes from Plan II to Plan I during a calendar year, the reverse is also true.

CHEMICAL DEPENDENCY TREATMENT BENEFITS

Except for the maximums noted on the following page, benefits are the same for Plan I and Plan II participants. Please note, the maximum payment for detoxification is $1,200 per calendar year. If you require additional detoxification services, you ill be responsible for the additional charges.

Services	Plan Payment	Your Co-payment	Maximums
Detoxification	100% of contracted charges*	$0	$1,200/calendar year
Inpatient Hospital	100% of contracted charges*	$250 co-payment per course of treatment	See next page
Residential Treatment Center	100% of contracted charges*	$0	See next page
Outpatient	100% of contracted charges*	$0	See next page

* Benefit Reduction – Chemical dependency treatment benefits are reduced by 50% where you fail to complete a recommended Chemical Dependency Treatment Program. Therefore, you could be responsible for payment of any and all charges in excess of 50%. ValueOptions will provide both you and the Plan with a certification evidencing completion when you complete a recommended Program.

Chemical Dependency Maximums

Plan I

• Annual: One course of treatment
• Lifetime: Two courses of treatment or $37,500

Plan II treatment courses are counted toward these maximums.

Plan II

• Annual: One course of treatment or $7,500
• Lifetime: Two courses of treatment or $10,000

Plan I treatment courses are counted toward these maximums.

Emergencies
If you or your dependent experience an acute mental health or chemical dependency emergency, you should call 911 or go directly to a hospital emergency room for care. Then call ValueOptions within 48 hours to report the emergency care. The ValueOptions staff will review the care, authorize coverage if the treatment is clinically necessary, and assess your further needs.

Prescription Drugs
Your prescription drug benefit, as described on pages 47 through 51, includes psychiatric medications (drugs used in the treatment of mental and nervous disorders). Simply follow the same procedures as for any other prescription drugs.

Psychological Testing
Psychological testing is not covered under ValueOptions. Payment may be considered under the major medical benefits in certain circumstances when medically necessary. No benefits are payable for testing ordered by a child’s school or for learning disabilities.

Transition to ValueOptions Coverage
You may have been receiving treatment from a non-ValueOptions provider prior to your eligibility for coverage under the mental health and chemical dependency benefit. To be covered by the program, you will need to arrange to transfer your care to a ValueOptions network provider. Call 1-866-277-5383 for details. Remember, benefits are payable only if pre-authorized by ValueOptions.

Out-of-Area Coverage
Benefits are provided exclusively through the ValueOptions network of providers. If you reside outside of a ValueOptions network area, ValueOptions will work with approved providers in your area to authorize services.

Coordination of Benefits For Mental Health and Chemical Dependency
If the Plan is your primary plan, your care must be pre-authorized by ValueOptions and provided by ValueOptions providers. If another group health plan, such as AFTRA, is your primary plan, this Plan will coordinate benefits as a secondary payor if you received care through your primary plan’s managed care network. In these cases, secondary benefits will be paid under the hospital and/or major medical portion of the Plan. Refer to the chart on next page.

In order to receive payment when the Plan is secondary, you should send a completed claim form, along with an itemized bill and the explanation of benefits (EOB) from your primary plan to the Plan Office.

Medicare Exception: If your primary carrier is Medicare and this Plan is secondary you are exempt from the rule. However, all Medicare-prime participants and dependents must access care through ValueOptions and are required to use Medicare Approved Providers in order to receive benefits. Your Medicare EOB should be sent to ValueOptions. No benefits for mental health and chemical dependency treatment are payable under the major medical benefit when Medicare is primary.