The Mental Health and Substance Abuse Plan

 AbleTo Support Program

 Free, confidential support program for medical events and life challenges

When working to recover feelings of sadness, anxiety and stress can take  a toll, keeping you from fully recovering and moving forward to your best life. AbleTo provides the help you need using a proven support program. AbleTo (pronounced "able to") connects you to licensed therapists and coaches to help you transition back into your life - all from the comfort of your own home.

Click here to learn more, or call the Live Healthy Team at 1-800-814-3543 (Monday - Friday 7am - 7pm CST) to ask about AbleTo.

 

The Costco medical plans pay benefits for Medically Necessary treatment of Mental Illness and Substance Abuse, including alcoholism. Mental Health and Substance Abuse (MHSA) benefits are subject to the same deductibles, co-pays and coinsurance as other Covered Expenses. To view how benefits are paid, please refer to the Medical Plan Summary in the Summary Plan Description.

Using Participating Behavioral Health Providers

As with most Covered Expenses, your Costco medical plan will pay a higher level of benefits for services you receive from participating providers. Aetna offers a nationwide network of Behavioral Health Providers including:

  • Licensed mental health professionals, such as psychiatrists, psychiatric physicians, clinical psychologists, clinical social workers, master level licensed therapists, marriage, family and child therapists, and certified psychiatric mental nurses.
  • Facilities, such as hospitals, psychiatric hospitals, and residential treatment facilities.

Click here to locate a participating Behavioral Health Provider near you or call Aetna customer service at 1-800-814-3543.

 What the Plan Covers

Office visits to Behavioral Health Providers for mental health or substance abuse care are covered the same as any other physician office visits – meaning that co-pays, co-insurance and annual deductibles do apply based on your medical plan.

The Care Network, your employee assistance program, offers short term counseling services at no-cost to employees and members of their household. Our program allows for up to six visits with a counselor for each event or issue.

The plans also pay benefits for intermediate short-term or intensive Hospital and other facility based services. Examples include inpatient care (24 hour a day hospitalization), Detoxification, Partial Confinement (overnight or daytime stays for conditions that do not require full-time hospitalization), and Intensive Outpatient Day Treatment.

To be covered, Hospital and facility-based services for mental health and substance abuse treatment must be:

1.      Pre-certified by Aetna as described in the section Pre-Certification of Healthcare Services of the Summary Plan Description,

2.      Medically Necessary and provided in a setting appropriate to the level of treatment required for your condition, and

3.      Part of a program of therapy prescribed and supervised by a Behavioral Health Provider which includes follow-up treatment. For Substance Abuse care, the follow-up treatment must be either:

  • directed by a Behavioral Health Provider on at least a monthly basis or
  • twice a month meetings with a certified organization devoted to the treatment of alcoholism or drug addiction.