mental health and substance use disorder planfor U.S.-payroll employees

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if you are enrolled in a medical HMO ...

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 Rule topic under The Basics section on this page for further important details.

the basics

The Mental Health and Substance Use Disorder (MHSUD) Plan for eligible U.S.-payroll employees provides confidential support for a wide range of personal issues – from everyday challenges to more serious problems. 

  • Beacon Health Options is the claims administrator.
  • You do not need to enroll. This benefit is automatically provided to you, as long as you’re eligible to participate. 
  • You do not pay a monthly cost for this coverage. Chevron currently pays the full monthly cost for coverage. However, you do share a portion of the costs if you receive benefits under the MHSUD Plan.

The MHSUD is a preferred provider organization (PPO) plan, so you can choose to see any provider you choose, network or out-of-network; however if you are enrolled in a Chevron Medical HMO Plan and choose to use behavioral health services under the MHSUD, you must visit a Beacon network provider for your services to be covered.  A network is a group of independent medical providers that have agreed with your medical plan claims administrators to charge contracted fees for services provided to plan members. Learn more about networks in the How To At-A-Glance section on this page.

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

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 Beacon Health Options, Beacon 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 Beacon Health Options. When you’ve reached the annual out-of-pocket maximum under your Chevron Medical HMO, contact Beacon Health Options 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

how to at-a-glance

If you and/or your dependents are eligible to participate, you're automatically covered. Enrollment in not required.

  • Your participation in the MHSUD Plan begins on your first day of your expatriate assignment.
  • Dependents begin participation in the MHSUD Plan when they begin participation in the Global Choice Plan. As a reminder, your dependent's Global Choice enrollment is dependent upon your successful completion of the dependent verification process
  • If you add or drop Chevron medical coverage for a dependent during the year, MHSUD Plan coverage for that dependent will automatically be added or dropped, too. 

If you're eligible to participate, you can verify the status of your coverage, including eligible dependents:

Tip: While your coverage starts the first day you are eligible, know that there is a slight delay before your coverage is activated with the claims administrators and for your coverage to display in the administrator's system. Please allow approximately 7 business days for BenefitConnect/HR Service Center to process your coverage eligibility with the claims administrators. If you have questions about your election, contact the HR Service Center. (Choose the option for Benefits, then Health coverage.)

ID cards for the Mental Health and Substance Use Disorder (MHSUD) Plan are not issued or necessary to receive care. If you need your Beacon Member ID number, contact Beacon Health Options directly. (See contact information at the bottom of this page.)

Tip: While your coverage starts the first day you are eligible, know that there is a slight delay before your coverage is activated with the claims administrators and for your coverage to display in the administrator's system. Please allow approximately 7 business days for BenefitConnect/HR Service Center to process your coverage eligibility with the claims administrators. If you have questions about your election, contact the HR Service Center. (Choose the option for Benefits, then Health coverage.)

A network is a group of independent medical providers in the U.S. that have agreed with your medical plan claims administrators to charge contracted fees for services provided to plan members.

Network Providers - Medical HMO Participants
When you're enrolled in a Chevron Medical HMO, the MHSUD plan pays benefits for covered treatment only when you use a provider in the Beacon Health Options network. 

  • Network providers charge discounted rates for covered services they provide to plan members and the plan benefits are based on these discounted rates. 
  • In addition, you do not have to file a claim form when you use a network provider.
  • The MHSUD pays for covered services from an out-of-network provider only for emergency services. If you use an out-of-network provider for non-emergency care, the services are not covered by the MHSUD Plan.
  • If there are no Beacon Health Options providers near your home, Beacon Health Options can help locate a qualified clinician or facility in your area and review their credentials for you. In cases like these, you may qualify for the network coverage level, even though the provider who treats you or your covered dependent isn’t a member of the Beacon Health Options network.  

Network Providers - All Other Chevron Medical Plans

If you go to a network provider ...

  • Generally, the plan pays a higher level of reimbursement for care when you use a provider in the Beacon Health Options network.
  • Network providers charge discounted rates for covered services they provide to plan members and the plan benefits are based on these discounted rates.
  • You do not have to file a claim form when you use a network provider.   

If you go to an out-of-network provider ...  

  • Generally, the plan pays lower benefits for care when you go to an out-of-network provider and the plan benefits are based on Allowed Charges. For services provided outside the U.S., allowed charges means billed charges.
  • You typically will be required to pay for the services when you receive them and submit a claim form to Beacon to be reimbursed.
  • If there are no Beacon Health Options providers near your home, Beacon Health Options can help you locate a qualified clinician or facility in your area and review their credentials for you. In cases like these, you may qualify for the network coverage level, even though the provider who treats you or your dependent isn’t a member of the Beacon Health Options network. 

Temporary Special Provision for Permian Basin Participants
The Temporary Special Provision for Permian Basin Participants under the Chevron MHSUD applies to certain out-of-network services for plan participants who maintain a permanent home address in one any of the specified zip codes in the Permian Basin.

How to Locate a Network Provider 

To locate a Beacon Health Options network provider:

  • Call Beacon Health Options. (See contacts at the bottom of this page.)
  • Access the Beacon Health Options website.
  • Contact Chevron Employee Assistance and Work Life Services. (See contacts at the bottom of this page.)

Services From a Network Provider
If you go to a Beacon Health Options network provider for care, you generally don’t have to file a claim form for network benefits. However, before your benefits can be paid, you must sign an authorization to release medical information. Your provider may give you the authorization form, or you can request the form from Beacon Health Options. Your provider will make arrangements with you if you need to pay for part of your treatment.   

Services From an Out-of-Network Provider
If your coverage permits you to see an out-of-network provider, or if you live in an area where there aren't any network providers, you may be billed directly by a provider. To be reimbursed for treatment, you’ll have to file a claim form with Beacon Health Options.  

To ensure timely payment, you should file your claim as soon as you can. If you don’t file a claim within 365 days from the date on which you incur a covered charge, no plan benefits will be payable for that covered charge. 

Reimbursement for Behavioral Health Travel
If you need to request reimbursement of travel expenses for covered behavioral health services, learn about the requirements and the process here

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. 

As a reminder, if you are enrolled in a Chevron Medical HMO Plan, 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 Beacon Health Options, Beacon 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 Beacon Health Options. When you’ve reached the annual out-of-pocket maximum under your Chevron Medical HMO, contact Beacon Health Options (see contact information at bottom of this page) and provide proof by submitting the explanation of benefits (EOB) available from your Medical HMO.

The MHSUD Plan ends the last day of the month in which your employment ends

  • You can elect COBRA coverage for you and your covered dependents for this plan. If you timely elect COBRA coverage, your MHSUD coverage will be retroactive to the date your active employee coverage ended. If you wish to continue coverage, you must make an election to continue it.
  • If you are eligible for and enroll in retiree health benefits
    • Coverage under the MHSUD plan continues only for non-Medicare-eligible pre-65 participants enrolled in the Chevron Medical PPO, High Deductible Health Plan (HDHP) or the High Deductible Health Plan Basic (HDHP Basic).
    • If you or an eligible dependent are enrolled in Chevron Medical HMO Plan, mental health and substance use disorder coverage is provided by your HMO plan.
    • If you or an eligible dependent is post-65 and/or eligible for Medicare, mental health and substance use disorder coverage is provided by your Medicare coverage.

Go to the Leaving Chevron resource on this website for more information about the things you need to do and the choices you need to make. 

plan documents

The summary plan descriptions (SPD) provides specific details about your benefits, such as eligibility, covered services and participation rules. If there recent updates to the SPD since the last publication date, look for the summary of material modification (SMM) included in the very front of the book.

The documents listed below are called a summary of material modification (SMM). An SMM explains recent updates to your plan that are not yet captured or updated in your summary plan description (SPD) since the last publication date. Be sure to review the SMM for an understanding of important plan updates.

Mental Health and Substance Use Disorder Service Changes

 

Deductible Changes

Permian Basin Participants

Other General Plan Changes

Review the Summary of Benefits and Coverage (SBC) to understand basic information about your plan, such as benefits, copayments, deductibles, and coinsurance. 

Chevron is legally required to provide certain notices to plan participants. These notices are posted on this website for your reference.

telebehavioral health services (virtual visits)

Telebehavioral health services through MDLIVE are available under the MHSUD Plan to employees eligible to participate in the plan.

To use telebehavioral health services:

  • Step One: Register for an MDLIVE account.
  • Step Two: Schedule a telehealth appointment from your MDLIVE account.
  • Step Three: Access your MDLIVE account at your scheduled appointment time. Appointments can be done from your computer connected to the internet from the secure MDLIVE website, from your mobile device through the app, or by phone if necessary.  

To be covered under the MHSUD Plan, telebehavioral health services:

  • Must be accessed through Beacon’s Telehealth service with an MDLIVE provider via telephone and/or secure video. Telebehavioral health services do not include consultations outside of the MDLIVE service.* MDLIVE is a provider group that is formally contracted as a group provider with Beacon Health Options.
  • Telebehavioral health services do not include email, text or fax consultations.
  • Must be for a covered condition under the MHSUD Plan and be deemed medically appropriate by Beacon Health Options.
  • Must be for a mental health and substance use disorder condition that Beacon has deemed appropriate for treatment through telebehavorial health services. Not all services, including the management of certain controlled medications, are appropriate for this type of remote treatment option.
  • Must be allowed under state law.

Keep in mind that the MHSUD Plan’s pre-certification and/or notification rules – if any – continue to apply depending on the type of service you receive. In addition, telehealth/telemedicine visits that occur within behavioral health facilities will not be covered. 

* Note that, due to the COVID-19 pandemic, coverage rules for telebehavioral health services have been extended to include telebehavioral health services provided by a non-MDLIVE provider via telephone and/or secure video. Read the full details about this temporary extension here.

Ordinarily, to be covered under the MHSUD Plan, telebehavioral health services must be accessed through Beacon’s Telehealth service with an MDLIVE provider via telephone and/or secure video. Telebehavioral health service is not covered outside of the MDLIVE provider group.
 
In recognition of current physical distancing requirements and the heightened need for behavioral health care during the COVID-19 pandemic, effective March 18, 2020 the following temporary rules apply under the Mental Health and Substance Use Disorder (MHSUD) Plan:

  • The MHSUD Plan coverage rules for telebehavioral health services will be extended to include telebehavioral health services provided by a non-MDLIVE provider via telephone and/or secure video.
  • This temporary extension for telebehavioral health services provided by a non-MDLIVE provider will be in effect beginning on March 18, 2020 until the end of the COVID-19 emergency period
  • Read the full details about this temporary extension here.
  • Online visits with a LiveHealth Online provider are considered office visits and follow your Anthem Plan’s standard Online Visits or Network Office Visit schedule of benefits.
  • You’ll see the cost for the visit, and you’ll need to provide a valid form of payment prior to proceeding with your online visit.
  • No claim forms or other filing with Anthem is needed when you use LiveHealth Online; the payment requested (if any) is your actual out-of-pocket cost for that service.
  • Anthem doesn’t cover prescription drugs for outpatient treatment – whether you’re visiting a provider in the office or through LiveHealth Online. If you are prescribed a drug as part of your online visit; you should use your prescription drug plan with Express Scripts to fill prescribed medication.

applied behavior analysis (ABA) coverage

When autism-related disorders are suspected, early diagnosis and intervention can have a positive effect on your child and your family. The MHSUD Plan includes coverage for Applied Behavior Analysis (ABA) treatment for those diagnosed with autism or pervasive development disorder (PDD). ABA includes many different techniques to increase useful or desired behaviors – such as communication and social skills – and reduce behaviors that may interfere with learning or may be harmful. 

The plan only pays benefits for covered charges for services and treatment that are medically necessary and appropriate, as determined
by the claims administrator.

  • Prior authorization or pre-certification with the claims administrator is required prior to services being delivered. You’re also required to obtain authorization on a recurring basis for continuing services, as required by the claims administrator.
  • Based on an initial review and concurrent review of the case, a case-specific quantity of ABA therapy services will be allocated.
  • Covered ABA services are paid according to the Outpatient Office Visit schedule of benefits. You will be responsible for any cost sharing that applies to you, including the deductible, copayments or coinsurance. 
  • You can visit any ABA licensed or certified provider, network or out-of-network*. But if you use of an out-of-network provider, covered services will be paid under the out-of-network portion of the MHSUD Plan, which means you’ll pay a larger share of the costs for service. Beacon Health Options can help you locate a network provider in your area. 
  • Review the MHSUD summary plan description for more information about how Outpatient Office Visit benefits are paid. 

* As a reminder, if you are enrolled in a Chevron Medical HMO and want to use the benefits provided by the MHSUD Plan, you're required to use a provider in the Beacon Health Options network to be eligible for coverage.

Covered ABA services may include:

  • Psychiatric evaluation to confirm the ASD diagnosis.
  • Psychological testing, as necessary to confirm the ASD diagnosis.
  • Individual, family, and group therapy. 
  • Medication management.
  • Applied Behavior Analysis (ABA) treatment.
  • Intensive Case Management for complex cases (individuals with extraordinary care needs).

The MHSUD Plan doesn’t cover prescription drugs for ABA treatment. If the covered individual is prescribed a drug as part of treatment, you
should check with your prescription drug plan 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. 

Covered diagnoses include autism, which is a general term used to describe a group of complex developmental brain disorders known
as Pervasive Developmental Disorders (PDD) within the American Psychiatric Association Diagnostic and Statistical Manual 5 (DSM 5). Autism Spectrum Disorder (ASD) is a type of PDD. Your benefit covers Applied Behavior Analysis (ABA) treatment for ASD.

The other covered pervasive developmental disorders are:

  • Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)
  • Asperger Syndrome
  • Rett Syndrome
  • Childhood Disintegrative Disorder

Only these diagnoses, along with a diagnosis of being at risk of autism or PDD, will be covered.

Prior authorization or pre-certification will be required for benefits to be paid. 

  • Call the claims administrator - Beacon Health Options - to obtain prior authorization or pre-certification.
  • Once authorization is complete, a Beacon Health Options representative will advise you that ABA therapy will be covered according to the MHSUD Plan’s benefits when provided or supervised by a ABA licensed or certified provider of services. 
support ABA therapy with rethink

Rethink is a service available to all U.S.-payroll employees eligible for Chevron health and welfare benefits. Parents caring for children with developmental disabilities or learning and behavior challenges can receive free, live teleconsultations with behavior experts to answer questions, and provide guidance and resources. Additionally, Rethink provides parents with over 1,500 easy-to-follow videos depicting behavior experts and educators teaching children skills such as language, socialization, self-help, academics, vocational, and more. Printable materials as well as on-demand web-based training complement these tools as parents support their children in reaching their top potential.

Rethink is not a health plan and does not provide diagnosis or health treatment, nor is the service a licensed ABA provider. Rethink only provides behavioral resources, tools and information, so a covered diagnosis is not required to take advantage of this service. While in-home ABA services directly impact your child's learning, Rethink is an online tool for you as a parent and caregiver to not only learn how to better address behavior challenges and communicate and interact with your child when the ABA provider is not there, but also supports you in collaborating with the ABA provider. Since they can use Rethink too, you can communicate more efficiently through the Rethink program, work on the same skills, and even share data if you wish.

contacts

The HR Service Center manages your enrollment in and eligibility for this benefit plan. For all other questions regarding your coverage, contact the claims administrator. A claims administrator manages the administration of your plan — for example, claims, account balances, ID cards, what's covered and what's not, provider networks, phone numbers, the administrator's website or mobile app, and more. 

mental health and substance use disorder plan (U.S.-payroll employees)

  • Plan Type  Mental Health and Substance Use Disorder
  • Eligibility  U.S. Payroll Employees
  • Enrollment  Coverage automatic, if eligible. View eligibility on BenefitConnect or call the HR Service Center.
  • Claims Administrator  Beacon Health Options
  • Phone - Beacon 1-800-847-2438 (714-763-2420 outside the U.S.)
  • Phone - MDLive For telebehavioral health services 1-888-430-4827
  • Website  www.achievesolutions.net/chevron
  • Virtual Visits / Telehealth  Access MD Live ǀ Learn more here
  • Claim form  Forms Library
  • Address  Beacon Health Options ǀ P.O. Box 1290 ǀ Latham, NY 12110

employee assistance and worklife services (EAP-WL)

  • Plan Type  WorkLife program
  • Eligibility  All Chevron employees
  • Enrollment  Coverage automatic, if eligible. To use services, reach out to EAP-WL directly.
  • Phone (Inside U.S.) 1-800-860-8205 
  • Phone (Outside U.S.) 925-842-3333 (CTN 842-3333) 
  • Website  hr.chevron.com/health-wellness/eap/default.aspx (intranet only)

rethink

Chevron Corporation believes the Chevron Corporation Mental Health and Substance Use Disorder Plan (the MHSUD Plan) is a grandfathered health plan under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator by calling the HR Service Center. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

This web page provides only certain highlights about changes of benefit provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will prevail to the extent permitted by law. Oral statements about plan benefits are not binding on Chevron or the applicable plan. There are no vested rights with respect to Chevron health care plans or any company contributions towards the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union-represented employees.