Managed Behavioral Health (Carve-out) Sample Design

Small Group

The Holman Plan:

Includes Employee Assistance Program, Care Management, Preauthorization/Utilization Review, and treatment through the Holman Network of providers and facilities.

The Employee Assistance Program provides the following services:

• Toll Free Nationwide 800 Number 24-Hours, 7 days a week
• Crisis line and crisis intervention
• Multilingual Interpreter Services Available in as many as 140 Languages *
• Clinical Account Manager
• Program Publicity
  • Tri-Fold Brochures
  • 800 Number Cards
  • Color Posters
  • Employee Newsletters
  • Articles on a Wide Array of Mental Health Topics
  • Website Access
• Employee Orientation and Supervisory Training on CD or Videotape
• Supervisory Training Manuals on How to Utilize the EAP as a Management Tool
• Regular statistical reports
• Wellness Seminars
• Community Referrals
  • 12-Step Groups
  • Support Groups
  • Attorney Service (Plus Free Phone Consultation)
  • Financial Counseling, Info and Planning
• Counseling For:
  • Drug/Alcohol Problems
  • Marital Conflicts
  • Adolescent Behavioral Problems
  • Stress-Related Problems
  • Family Conflicts
  • Other problems that relate to an employee's mental well being

Benefits Schedule:

• Employee Assistance Program (Contracted Providers):
  • 1-2 Private/Group Face-to-Face Counseling Sessions: $0 Co-payment.
• Outpatient Expanded Sessions (Contracted Providers):
  • Private Sessions:
    • Number of Private Sessions - 3-50
    • Amount of copayment - $25
  • Group Sessions:
    • Number of Group Sessions - 3-50
    • Amount of copayment: $15
• Intensive Outpatient (Contracted Providers):
  • 10% copayment
• Subacute, Alternative Inpatient Care, Day Treatment Residential & Partial Hospitalization (Contracted Providers):
  • No Deductible
  • 20% Co-payment of Negotiated Rates
• Acute Care (Contracted Providers):
  • $200 Deductible per Admission
  • 20% Co-payment
• Emergency Ambulance Services:
  • 20% Co-payment
• Emergency Out-of-Network Benefit:
  • $200 Deductible per Admission
  • 50% Co-payment Up to $500 per Day Paid

The Mental Health Inpatient Benefits Include:

• 20 Acute Care days per Enrollee/per Year.
• 1 Acute Care Day = 2 Subacute Days.

Rate: $28.46 per Employee/per Month
Minimum Premium: $1500.00 per Month

Employee Orientation, Supervisory Training, Health Fairs and Wellness Seminars can be provided for $150.00 per hour plus travel expenses or can be included in the rate.