Benefits for Enlisted Members:

The Commonwealth provides members and their eligible dependents with mental health counseling services.  This benefit is administered by Pennsylvania Blue Shield in accordance with the plans listed below.

The Member Assistance Program strongly recommends that anyone who chooses to utilize mental health counseling benefits to contact Blue Shield prior to your first appointment.  This will ensure all the necessary information is in place for ensuring payment according to your plan. 
The number to call for either the Indemnity Plan (Classic Blue) or the Preferred Provider Option (PPO) is 1-866-727-4935.

INDEMNITY PLAN (Classic Blue):
This benefit provides up to 12 free psychotherapy visitsfor each member and each eligible dependent per contract year (July 1through June 30).  A member or dependent may use a licensed psychologist or psychiatrist of their choice.  Claims will be processed through Blue Shield under the following conditions:

• If a Blue Shield participating provider (psychologist or psychiatrist) is chosen,payment will be made in full and the member or dependent will have noout-of pocket expenses.
• Any additional visits beyond the 12 visitspayable, will be eligible under Major Medical, subject to any deductable and co-insurance amounts required under Major Medical Services.
• If a non-participating provider is chosen, Blue Shield will reimburse 100% of the PRC (Providers Reasonable Charge), approximately $25.00 to 50.00, and the member ordependent will be responsible for any difference between the PRC andthe providers charge.  If you use a non-participating provider, you should contact Blue Shield and the provider to inquire about charges that may incur prior to your first appointment with the non-participating provider.   

PREFFERED PROVIDER OPTION (PPO):
This benefit provides up to 60 psychotherapy visitsfor each member and each eligible dependent per calendar year (January1 through December 31).  Additionally, each member or dependent isrequired to pay a $25.00 co-pay per visit.  A member or dependent may use a licensed psychologist or psychiatrist of their choice that is listed within the PPO network.  Claims will be processed through Blue Shield under the following conditions:

• If a Blue Shield PPO in-network participating provider (psychologist or psychiatrist) is chosen, payment will be made in full and the member or dependent will be responsible for a $25.00 co-pay per visit.
• If a non-participating provider is chosen, the member or dependent will be required to pay for the services out-of pocket until a $250.00 deductible is met. After the deductible is met all expenses may be submitted to Blue Shield for reimbursement consideration.  If you use a non-participating provider, you should contact Blue Shield and the provider to inquire about charges that may incur prior to your first appointment with the non-participating provider. 

If youhave questions whether the Psychologist/Psychiatrist is a licensed BlueShield provider, contact Pennsylvania Blue Shield (1-866-727-4935).