This benefit is available only if you are enrolled in the Retired Trust Medical Plan.

If you need help, you should call the Providence Health System EAP at one of these toll-free numbers: In Oregon, 1-800-255-5255; in Portland, 503-215-3561. The Providence Health System EAP will evaluate your situation, then direct you to an eligible facility if you need treatment. This health care facility will be licensed by the state or accredited by the Joint Commission on Accreditation of Hospitals.

The type of treatment you receive for chemical dependency is called a "setting." Each setting costs a certain amount, depending on the kind of treatment administered. The total amount payable for all settings given within a 24-month period is $20,000. The 24-month period starts on the day of your first setting, and ends on the last day of the 24th month after your first setting. The $20,000 limit applies to any combination of inpatient, residential, day or partial hospitalization, and outpatient care. (Kaiser, Providence Open Option participants will be paid benefits in accordance with the Kaiser, or Providence plans.)

Your treatment may include settings at a residential facility or through day or partial hospitalization programs that provide full-time or part-day treatment. Or you may receive treatment by appointment through an outpatient service. All of these facilities and programs must be licensed and approved by the Mental Health Division of the Office of Alcohol and Drug Abuse Programs.

All of your covered charges will be reimbursed at 70% (80% for a Preferred Provider and 80% if there are fewer than two Preferred Provider primary care physicians within a 30 mile radius of your primary residence), subject to your annual deductible. None of the covered charges apply to your out-of-pocket maximum.

If you need a physical exam as part of your chemical dependency treatment program, you should contact the Plan Administrator. They will give you information about coverage through the Wellness Program or this Plan.

Your benefits will renew, in full, on the first day of the 25th month of coverage after your first use of a treatment program. If you enroll in a chemical dependency program but do not complete it, and have reached the 24-month maximum benefit amount, you will have to apply directly to the Board of Trustees to reenroll in another treatment program.

1. A licensed physician (MD or DO);
   
2. A psychologist (PhD) or other person licensed as a psychologist by the state in which he or she practices;
   
3. A clinical social worker; or
   
4. A licensed nurse practitioner.

1. Facilities, programs, and providers that are licensed by the state and approved by the Mental Health Division of the Office of Alcohol and Drug Abuse Programs;
   
2. Programs that are accredited for the particular level of care by the Joint Commission on Accreditation of Hospitals or the Commission on Accreditation of Rehabilitation Facilities;
   
3. Inpatient programs provided by a licensed health care facility;
   
4. Licensed facilities or residential programs for overnight stays or 40-hour weekly programs; or
   
5. Programs where the staff is directly supervised, or where the treatment plans are approved, by licensed medical or osteopathic
   physicians, psychologists, nurse practitioners or clinical social workers and that meet the standards of the Mental Health Division of the Office of Alcohol and Drug Abuse.

1. Charges resulting from educational programs for drinking drivers or from volunteer mutual support groups; and
   
2. Treatment solely for detoxification or primarily for maintenance care (the providing of an environment without access to drugs or alcohol).

1. You must be covered by the Plan to be eligible for chemical dependency benefits.
   
2. Your $20,000 chemical dependency benefit is for all treatment that you receive and for which you are charged during a 24-month period.
   
3. Your benefits will renew in full on the first day of the 25th month of coverage following your first treatment program.
   
4. If you are covered by Kaiser or Providence Open Option, your benefits will be paid in accordance with those plans.
   
5. All covered charges are reimbursed at 70% (80% for a Preferred Provider and 80% if there are fewer than two Preferred Provider primary care physicians within a 30 mile radius of your primary residence) of the covered charges and are subject to the annual deductible. None of the covered charges apply to your out-of-pocket maximum.
   
6. If your treatment program requires a medical exam, call the Plan Administrator.
   
7. You must receive treatment from authorized providers.