68 Substance Use Disorder Treatment The Facility, Practitioner, and Medical Support Charges that are incurred for the treatment of alcoholism, drug or chemical dependence are covered medical charges under the terms of the Plan, provided each element meets all the requirements of the definition of covered medical charge, as well as the Substance Use Disorder Treatment Services definition. No charges, other than those listed above, for treatment of alcoholism, drug, or chemical dependence are covered medical charges under this Plan. Charges for Substance Use Disorder Treatment Services will be covered only if the treatment of the covered individual is provided by a Hospital, a Substance Use Disorder Residential Treatment Center, a physician, a psychologist holding a Master or Doctorate in Psychology, or another similarly degreed practitioner legally licensed to provide Use Disorder Treatment by the state in which he or she practices. Coverage of these services is provided under the Plan for both inpatient and outpatient Use Disorder Treatment Services, including both detoxification and rehabilitation. Covered services also may include inpatient care at a Use Disorder Residential Treatment Center, Partial Hospitalization and Intensive Outpatient Therapy programs. The Plan does not cover diagnoses such as learning, behavioral and developmental disorders under this benefit or any other benefit. Neither does the Plan cover therapies such as art, music, drama, and recreational under this benefit. Surgical Vision Correction For Plan A+ participants , the charges for surgical vision correction that meet all the requirements of the definition of covered medical charge are covered under the terms of the Plan. The requirement that charges are paid only for a benefit that is Medically Necessary does not apply to this benefit. Allowable charges for this benefit include all related charges for exam, surgery, pre- and post-operative testing, and facility, as well as corrective lenses to be implanted during cataract surgery. The Plan will pay no more than $1,000 per eye, and $2,000 maximum for both eyes, for all related services incurred during the lifetime of the participant. There is no other benefit under the terms of the Plan for services in connection with surgical vision correction. Telehealth Telehealth is the delivery of health-related services and information via telecommunications technologies, including telephones, smartphones and personal computers, for virtual consultations. CareFirst Administrators Telehealth Connection is a telemedicine program providing access to certain telehealth services as part of your medical plan through CareFirst Administrators. It includes live appointments with board- certified doctors, via secure video or phone, who may diagnose and prescribe, when appropriate. Telehealth is not intended to replace your Primary Care Physician (PCP). Telehealth is designed to handle minor, non-emergency medical issues for eligible employees and their covered dependents enrolled in a medical plan through CareFirst Administrators. This program is accessible, 365 days a year, from most locations in the United States with an internet connection, or a US-based phone number that can receive a call back.
BTF Summary Plan A/A+ Page 72 Page 74