mental health and substance use disorder plan

Employees

• You are automatically covered by the MHSUD if you're a U.S.-payroll employee and you're eligible for Chevron's health benefits. You do not have to be enrolled in a Chevron medical plan to be covered by the MHSUD.

Dependents

• Your eligible dependents are also covered, they are enrolled in a medical plan to which Chevron contributes. If your eligible dependents are enrolled in any of the medical plans offered by Chevron, they are also automatically enrolled in the MHSUD Plan. If your dependent is not enrolled in a medical plan to which Chevron contributes, then your dependent cannot participate in the MHSUD Plan.
• Eligible dependents generally include your spouse or domestic partner and children under the age of 26.
• Special rules apply to dependents that are incapacitated or physically or mentally disabled. If you feel that your dependent may qualify to continue coverage beyond age 26 due to being incapacitated or physically or mentally disabled, contact the HR Service Center, in advance of your dependent turning age 26, for further assistance and instructions about how to certify your dependent to be eligible for coverage.

Dependent Verification Process

You are required to verify the eligibility of any new dependents you enroll in your Chevron medical plan in a dependent verification process. You have up to 60 days to obtain and submit requested documentation that verifies your dependent(s) are eligible to participate in Chevron’s medical benefits. If you don’t provide acceptable documentation by the deadline, your dependent(s) will be disenrolled from coverage and will therefore also be ineligible for the MHSUD Plan. Learn more about this process.

Expatriates

• U.S.-payroll expatriates on an expatriate assignment are eligible to participate in this plan.
• Learn more about how your coverage changes while on assignment.

The MHSUD covers treatment as a result of a diagnosis of a mental illness or substance abuse. It also covers treatment for mental health and substance abuse concerns including services for depression, stress and anxiety, family or relationship issues, personal or work concerns, drug and alcohol recovery, dealing with domestic violence, eating disorders, and others. Coverage features to note include:

• How the plan works depends on which Chevron-sponsored medical plan you choose, if any. What the plan covers and does not cover is the same for all participants. However, the plan's annual deductible(s), out-of-pocket maximum(s), network and out-of-network rules, and copayments or coinsurance may vary depending on your medical plan enrollment. Reference the summary plan description (SPD), posted on the Plan Documents section later on this page, for further information.
• The plan only pays benefits for covered charges for services, supplies, and treatment that are medically necessary and appropriate, as determined by the claims administrator.
• If you are enrolled in a Chevron Medical HMO Plan, you have the choice to use the behavioral health benefits provided by your HMO Plan, or to use the benefits provided under the MHSUD Plan. However, you cannot make a claim to both your HMO Plan and the MHSUD Plan for the same service. See the HMO Rules tab in this section for further information.
• The plan doesn’t cover prescription drugs for outpatient office visit treatment. If you’re prescribed a drug as part of your outpatient treatment, you should check with your medical plan prescription drug administrator to find out if it can help pay for the drugs you need; otherwise, you’ll be responsible for paying the full cost of prescribed outpatient medication.
• In certain situations, to receive the full benefits, you have to follow certain notification or pre-certification procedures. If you do not follow notification procedures when required, you may pay a higher percentage for your care. 
• The plan includes coverage for virtual visits - also called telebehavioral health services - as part of your benefit coverage. See the Telebehavioral Health Services section later on this page for more details.
• The MHSUD Plan includes coverage for Applied Behavior Analysis (ABA) treatment for those diagnosed with autism or pervasive development disorder (PDD). See the Applied Behavior Analysis (ABA) Coverage section later on this page for more information. 
• Access to a behavioral health travel benefit to help cover the cost of travel for those who cannot access the care they need where they live.
• A temporary special provision is available for plan participants who maintain a permanent home address in one any of the specified zip codes in the Permian Basin. Learn about the special provision.

To see the current year deductible amounts for this plan, reference the plan comparison or other plan documents posted on this page.

Your Chevron plan is structured into three cost sharing phases: deductible, coinsurance, and covered (when you reach your out-of-pocket maximum). At the beginning of the plan year, you are responsible for paying most costs until you satisfy the deductible, but as you move from phase to phase, your Chevron plan pays more of the costs.

A deductible is the amount you must pay out-of-pocket for the covered care you receive before your plan begins to pay a share of costs through coinsurance or copayments. The MHSUD Plan's annual deductible(s) vary depending on your medical plan enrollment, if any.

If you are waiving Chevron medical coverage ...

• If you are waiving Chevron medical coverage, there is no annual deductible for the MHSUD. 

If you are enrolled in the Chevron Medical PPO Plan ...

• If you are enrolled in the Chevron Medical PPO Plan, there is no annual deductible for the MHSUD. 

If you are enrolled in a Chevron Medical HMO Plan

• If you are enrolled in a Chevron Medical HMO Plan, there is no annual deductible for the MHSUD.

If you are enrolled in the Global Choice Plan (U.S.-Payroll Expatriates) 

• If you are enrolled in the Global Choice Plan (U.S.-Payroll Expatriates), there is no annual deductible for the MHSUD.

If you are enrolled in the Chevron High Deductible Health Plan (HDHP) or Chevron High Deductible Health Plan Basic (HDHP Basic)  ...

• There is a deductible for the MHSUD if you are enrolled in the HDHP or HDHP Basic. 
• There is a combined deductible for medical and prescription drugs (both retail and mail-order) under the HDHP/HDHP Basic and behavioral health services you receive under the MHSUD. You must satisfy your combined deductible before the MHSUD Plan shares the cost of behavioral health services. This means you must pay out-of-pocket for covered behavioral health services until you reach the combined deductible. When you reach the HDHP or HDHP Basic network combined deductible amount, as applicable, you will also have met the MHSUD Plan’s annual deductible and the MHSUD Plan will begin to share the cost of covered behavioral health services with you.
• The deductible amount for covered behavioral health services under the MHSUD is the same, regardless if you see a network or an out-of-network provider. 
• If you are covering dependents, each covered individual has a maximum deductible limit equal to the You Only network deductible amount. This means no more than the You Only deductible amount can be applied for any one person to satisfy the overall applicable deductible amount when you're enrolled in the You + One Adult, You + Child(ren), and You + Family coverage tiers. 

Learn More

• You can review the plan's summary plan description, included in the Plan Documents section of this page, to understand more about how the deductible works and what services do or do not apply toward meeting your annual deductible.

To see the current year out-of-pocket maximum amounts for this plan, reference the comparison or other plan documents posted on this page.

Your Chevron plan is structured into three cost sharing phases: deductible, coinsurance, and covered (when you reach your out-of-pocket maximum). At the beginning of the plan year, you are responsible for paying most costs until you satisfy the deductible, but as you move from phase to phase, your Chevron plan pays more of the costs. When you reach the out-of-pocket-maximum (OOP) your Chevron MHSUD Plan pays 100% of covered services for the remainder of the plan year. The MHSUD Plan's out-of-pocket maximum(s) vary depending on your medical plan enrollment, if any. 

If you are waiving Chevron medical coverage ...

• You and the MHSUD Plan share the cost of covered behavioral health charges until you reach the annual out-of-pocket maximum. When you reach your out-of-pocket maximum, the plan pays 100 percent of all covered behavioral health charges until the end of the calendar year. 

If you are enrolled in the Chevron Medical PPO Plan ...

• You and the MHSUD Plan share the cost of covered behavioral health charges until you reach the annual out-of-pocket maximum. When you reach your out-of-pocket maximum, the plan pays 100 percent of all covered behavioral health charges until the end of the calendar year.
• There is a combined annual out-of-pocket maximum for medical and prescription drugs (both retail and mail-order) under the Medical PPO and behavioral health services you receive under the MHSUD. You must satisfy your combined out-of-pocket maximum before the MHSUD Plan pays 100 percent of all covered behavioral health charges. When you reach the Medical PPO network combined out-of-pocket maximum amount, as applicable, you will also have met the MHSUD Plan’s annual out-of-pocket maximum and the MHSUD Plan pays 100 percent of all covered behavioral health charges until the end of the calendar year.*

If you are enrolled in the Chevron High Deductible Health Plan (HDHP) or Chevron High Deductible Health Plan Basic (HDHP Basic)  ...

• After you reach your combined annual deductible, you and the MHSUD Plan share the cost of covered behavioral health charges until you reach the annual out-of-pocket maximum. When you reach your out-of-pocket maximum, the plan pays 100 percent of all covered behavioral health charges until the end of the calendar year.
• There is a combined annual out-of-pocket maximum for medical and prescription drugs (both retail and mail-order) under the HDHP/HDHP Basic and behavioral health services you receive under the MHSUD. You must satisfy your combined out-of-pocket maximum before the MHSUD Plan pays 100 percent of all covered behavioral health charges. When you reach the HDHP or HDHP Basic network combined out-of-pocket maximum amount, as applicable, you will also have met the MHSUD Plan’s annual out-of-pocket maximum and the MHSUD Plan pays 100 percent of all covered behavioral health charges until the end of the calendar year.*

If you are enrolled in a Chevron Medical HMO Plan

• You and the MHSUD Plan share the cost of covered behavioral health charges until you reach the annual out-of-pocket maximum. When you reach your out-of-pocket maximum, the plan pays 100 percent of all covered behavioral health charges until the end of the calendar year. 
• There is a combined annual out-of-pocket maximum for medical and prescription drugs (both retail and mail-order) under your Medical HMO and behavioral health services you receive under the MHSUD. You must satisfy your combined out-of-pocket maximum before the MHSUD Plan pays 100 percent of all covered behavioral health charges. The out-of-pocket maximum in effect for you during a calendar year is the lowest out-of-pocket maximum amount under all the Chevron Medical HMOs in your corresponding group of plans.
• Out-of-pocket expenses will need to be tracked if you’re enrolled in a Medical HMO and are using MHSUD Plan benefits.
  • For claims submitted to Carelon, Carelon will track your eligible covered behavioral health charges under the MHSUD Plan.
  • Chevron Medical HMO plans are not able to exchange medical out-of-pocket amounts with Carelon. When you’ve reached the annual out-of-pocket maximum under your Chevron Medical HMO, contact Carelon and provide proof by submitting the explanation of benefits (EOB) available from your Medical HMO.

If you are enrolled in the Global Choice Plan (U.S.-Payroll Expatriates) 

• You and the MHSUD Plan share the cost of covered behavioral health charges until you reach the annual out-of-pocket maximum. When you reach your out-of-pocket maximum, the plan pays 100 percent of all covered behavioral health charges until the end of the calendar year.
• There is a combined annual out-of-pocket maximum for medical and prescription drugs (outside the U.S.) under the Global Choice Plan and behavioral health services you receive under the MHSUD. You must satisfy your combined out-of-pocket maximum before the MHSUD Plan pays 100 percent of all covered behavioral health charges. When you reach the Global Choice network combined out-of-pocket maximum amount, as applicable, you will also have met the MHSUD Plan’s annual out-of-pocket maximum and the MHSUD Plan pays 100 percent of all covered behavioral health charges until the end of the calendar year.*

Learn More

• You can review the plan's summary plan description, included in the Plan Documents section of this page, to understand more about how the out-of-pocket maximum works and what services do or do not apply toward meeting your annual out-of-pocket maximum.

* If you are covering dependents, each covered individual has a maximum out-of-pocket limit equal to the You Only network out-of-pocket maximum amount. This means no more than the You Only out-of-pocket maximum amount can be applied for any one person to satisfy the overall applicable out-of-pocket maximum amount when you're enrolled in the You + One Adult, You + Child(ren), and You + Family coverage tiers.

If you are enrolled in a Chevron Medical HMO Plan, you have the choice to use the behavioral health benefits provided by your HMO Plan, or to use the benefits provided under the MHSUD Plan. However, you cannot make a claim to both your HMO Plan and the MHSUD Plan for the same service.

• If you choose to use the MHSUD Plan benefit, you must use a network provider to receive benefits. Out-of-network benefits are not covered, except for emergency services. If you use the MHSUD Plan benefit, there is no deductible to satisfy.
• If you use the benefit provided by your Medical HMO, your HMO's deductible may or may not apply. Contact your HMO for additional information about this benefit, including additional plan rules that may apply.

For employees in the Permian region

Access information about the temporary special provision available for plan participants who maintain a permanent home address in one of the specified zip codes in the Permian Basin. 

• Learn about the special provision.
• View eligible zip codes (page 5).