Mental Health and Substance Use Disorder Benefits and Member Assistance Program (MAP)
The health of our participants—both mental and physical—is our top priority. With mental health and substance use disorder issues on the rise, especially in our community, we want to make sure that getting qualified, professional help is as easy as possible for our members and their families.
For more information, refer to this overview brochure.
Member Assistance Program (MAP)
The Health Benefit Plan has partnered with Lyra Health to administer our Members Assistance Program (MAP). Lyra provides free, personalized guidance by licensed professionals on evidence-based treatment for mental health issues.
You can contact Lyra if you are:
- Looking for ways to improve your resilience
- Worried about someone you care for
- Facing depression and/or anxiety
- Dealing with substance use disorder issues
- Struggling with everyday obligations
Participants are eligible for up to 16 free sessions for mental health coaching and/or therapy per individual, per calendar year with a Lyra provider. If you need ongoing support, the MAP can refer you to the right resources.
If your provider isn’t in the Lyra network…
Don’t worry! Lyra administers our member assistance program, but mental health coverage is available through Blue Cross Blue Shield. If you’re looking for a mental health provider, you can check the BCBS network. Visit www.bcbsil.com and “Find Care” to start your search. In-network mental health services are covered at 100%!
The MAP also offers free, 30-minute consultations with a financial counselor and/or CPA, and free identity theft and fraud protection (including a 60-minute consultation with a fraud specialist). Referrals to providers who offer their services at discounted rates may also be available.
Lyra also provides work-life services to help you work through personal life obstacles. These services include legal, identity theft, financial, and dependent care services.
Free financial planning
- 30-minute consultation with a financial counselor
- 30-minute consultation with a CPA
Free identity theft and fraud protection
- 60-minute consultation with a fraud resolution specialist
- Free ID emergency response kit
Free legal assistance
- Free 30-minute consultation with an attorney or mediator
- Access to 24-hour emergency support
Free parenting, pet, and elder care resources
Additional Therapy and Services
In addition to the 16 mental health coaching and/or therapy sessions you have through Lyra, you may access additional therapy and medication management sessions using the Blue Cross Blue Shield BlueCard PPO.
Blue Cross Blue Shield BlueCard PPO offers a large network of mental health care and substance use disorder treatment providers, including hospitals, outpatient facilities, residential settings, psychiatrists, psychologists, and licensed therapists.
You can see any provider, but you’ll pay less for care when you see network providers. These providers discount their fees. If you use non-network providers, you must pay your provider at the time of service and submit claims to the Benefits Office. Refer to this Summary of Material Modifications for details.
|Blue Cross Blue Shield BlueCard PPO Provider||Out-of-Network Provider|
|Plan Pays||You Pay||Plan Pays||You Pay|
|Mental Health Inpatient Care||100% of contracted rate||0%||75% of UCR* rate||25% of UCR rate plus amount over UCR rate|
|Mental Health Outpatient Care||100% of contracted rate||0%||75% of UCR rate||25% of UCR rate plus amount over UCR rate|
|Substance Use Disorder Inpatient and Outpatient Care||100% of contracted rate||0%||75% of UCR rate||25% of UCR rate plus amount over UCR rate|
* UCR stands for Usual, Customary, and Reasonable—the standard rate set for services in a particular area.
There is no deductible for in- or out-of-network claims.
Coordinating Your Care (Kepro)
For complex mental health and/or substance use disorder cases, you may need or want to work with Kepro. Kepro is the Plan’s partner for care navigation, case management and precertification (prior authorization) for mental health and substance use disorder care.
Contact Kepro at 800-634-4832, 8 a.m.–8 p.m. ET, Monday–Friday
Care navigation is a handy resource for you and your family if:
- You want to explore various treatment options or cost considerations, or find a qualified provider.
- You need help coordinating your own care or care for your spouse or child.
- You seek treatment and could benefit from additional resources.
Precertification or prior authorization
Certain kinds of care require precertification. Kepro’s precertification phone number is 800-634-4832. If you or a family member is admitted to a treatment facility or hospital, let your provider know that the precertification information is on your Blue Cross Blue Shield medical ID card. They can work with Kepro to make sure your inpatient treatment is certified.
You may be assigned a Kepro clinical Case Manager if your mental health or substance use disorder treatment needs additional attention and support.
While you’re not required to engage with a Case Manager, they can provide education on health conditions, medications, and treatment plans.