1199SEIU Funds Insurance Coverage for Drug and Alcohol Rehab Treatment

Does 1199SEIU Fund Insurance Cover Alcohol and Drug Rehab?

If you’re one of the more than 450,000 people covered by 1199SEIU Fund insurance from Florida, the Maryland and DC area, Massachusetts, the New York City and Long Island area, or upstate New York, you may be wondering whether your plan will help cover some or all of the costs of alcohol and drug rehab.^{1, “Health Benefits” and “Find Your Benefits”}

Specifically, more than 200,000 1199SEIU members have comprehensive health care coverage, which includes coverage for hospitalizations, dental and vision care, doctors’ visits, and prescription drugs.^{1, “Health Benefits”} Coverage may extend to alcohol and drug rehab costs.

The best way to find out what’s covered under your plan is to verify your benefits and coverage details. Rehab centers can help you check your specific coverage based on the insurance information that you provide them. You can also call the number on the back of your 1199SEIU insurance card for more information about your specific plan’s coverage details.

What Is 1199SEIU Fund?

The 1199SEIU Funds aren’t specifically health insurance plans but rather a large labor-management fund available to working and retired healthcare industry workers in specific states across the country.² Approximately 450,000 industry workers, members of 1199SEIU United Healthcare Workers East, and their families receive quality health benefits, as well as training, educational, job security, and childcare benefits at little to no out-of-pocket costs.² Upon retirement, members also enjoy defined monthly pensions.²

1199SEIU Fund began in 1945 when it was known as the Local 1199 Benefit Plan.² It was initially designed to provide 300 New York City retail drugstore workers with health, disability, and life insurance benefits.² Three years later, the Benefit Plan became a self-insured and self-administered fund.² It has continued to grow, and more funds were added to the initial plan to provide quality benefits to members. Today, 4 benefits funds, which are jointly administered, provide comprehensive benefits packages to 400,000 members, retirees, and their families.²

What Will 1199SEIU Fund Insurance Cover?

What the 1199SEIU Fund health benefits will cover will vary. Despite coverage details, the 1199SEIU Funds may cover some or all the cost of the following drug and alcohol rehab treatments:

• Inpatient or residential rehab. With inpatient or residential rehab treatment programs, you would stay at the facility or rehab center for a set period of time. During your stay, you would receive round-the-clock assistance and medical supervision, which could include medical detox.^{3, Pg 8, “What types of treatment programs are available?” Para 2}
• Outpatient rehab or therapy. With outpatient rehab or therapy programs, you would go to a facility once or twice a week to receive your care. Care could include group meetings or individual counseling, or therapy sessions. No overnight stay is required.^{3, Pg 10, Para 2}
• Intensive outpatient programs (IOP). With an IOP treatment, you would travel to a facility (like an outpatient program) and receive your therapy or counseling care. However, there are typically more sessions per week with an IOP, which provides more structure than standard outpatient programs.^{3, Pg 10, Para 3}
• Partial hospitalization programs (PHP). With a PHP, you would attend treatment at a facility for 4 to 8 hours each day, multiple days a week. This program is commonly known as a day program, as you’d spend your day(s) receiving treatment. Common forms of PHP treatment include counseling, therapy, or medication-assisted treatment.^{3, Pg 10, Para 1}

Please note that although these are common treatment methods, they may not be recommended for you on your unique path to recovery. Be sure to check with your provider and follow their treatment instructions.

Does 1199SEIU Fund Insurance Cover Mental Health Treatment Facilities?

While specific coverage details typically vary based on the specific fund you’re a member of, plans will provide some level of coverage for mental health services. This is because insurance providers are mandated by the federal health care reform law, called the Affordable Care Act (ACA), to provide coverage for mental health care and treatment.⁴ Specifically, providers must provide coverage in some capacity for substance use disorder treatment (such as rehab), inpatient mental and behavioral health services, and outpatient behavioral health services.⁴

What this means for you is that, whether you need stand-alone heroin rehab or co-occurring disorder treatment, your 1199SEIU Fund insurance should provide some level of coverage. A co-occurring disorder occurs when someone experiences both a mental illness and substance use disorder simultaneously.⁵

Co-occurring disorders are fairly common, as those with a substance use disorder are twice as likely to develop a mental illness at some point in their life, and vice versa.⁶ While one doesn’t directly cause the other, it can exacerbate or increase the risk of developing the other.⁵ As such, modern treatment recommendations involve an integrated treatment approach, where each condition is treated separately but at the same time.⁵

How Long Does 1199SEIU Fund Insurance Cover Rehab?

The length of time that your 1199SEIU Fund insurance plan will cover rehab treatment will vary based on your specific plan. Each 1199SEIU Fund’s health benefits may offer differing levels of coverage. The best way to find out what’s covered under your plan is to look up your own plan information on your insurance card. You can also call the number on the back of your insurance card to review your plan’s details.

Despite what is covered by your insurance plan, it’s important to prioritize remaining in treatment for a long enough time. Longer treatment times are generally considered to be the most effective, but every person’s individual needs are different. Specifically, treatment programs should last at least 3 months, according to research, as this amount of time helps reduce or stop drug use and improve overall outcomes.^{7, bullet 5}

What if My 1199SEIU Fund Policy Does Not Cover Rehab?

If your 1199SEIU Fund health policy doesn’t fully or partially cover the cost of rehab, you may be responsible for paying for the remaining costs of rehab out-of-pocket. Depending on the rehab center that you choose to attend, there may be alternate payment options, like financing or scholarship opportunities, available to you.

Be sure to ask rehab staff whether these payment options are available if your insurance doesn’t cover the costs of your care. Getting the treatment you need right now is critical — don’t push it off down the road.

1199SEIU Fund In-Network vs. Out-of-Network Rehab Centers

To find an approved, or in-network, 1199SEIU recommends you contact Member Services at 646-473-9200.⁸ When seeking out care, it’s important to remind surgeons or doctors to refer you to only participating providers.⁸ If you see a provider that is out-of-network with your 1199SEIU benefit plan, which means that the provider isn’t contracted with your plan, you may be fully responsible for paying for the costs of care out-of-pocket.

1199SEIU Fund Plans

There are 6 different benefit funds available through 1199SEIU Funds.⁹ Each fund may offer different mental and behavioral health benefits coverage. Here’s a list of the different 1199SEIU Fund plans:⁹

• 1199SEIU National Benefit Fund. Eligible enrollees and covered members may receive coverage for mental health, alcohol, and substance use issues. In-person, phone, and online talk therapy are covered so long as it is done through Teladoc or an in-network provider with no need for a referral or prior authorization.¹⁰ PHP and alcohol and substance use disorder inpatient detox and rehab may also be covered under this plan.¹⁰
• 1199SEIU National Benefit Fund for Rochester Members. Eligible enrollees should check their specific Summary Plan Description to review the types of mental and behavioral health benefit coverage details.¹¹
• 119SEIU Greater New York Benefit Fund. Covered members may receive inpatient and outpatient services for mental health, behavioral health, or substance use services from a participating provider at no charge.^{12, pg. 4} If you see a non-participating provider, you will pay whatever the provider charges.^{12, pg. 4}
• 119SEIU Greater New York for New Jersey Fund. Covered members may receive mental health, behavioral health, or substance abuse services from a participating provider at a $10 copay per visit for outpatient services and 15% coinsurance for inpatient services.^{13, pg. 4} If you see a non-participating provider, there is no coverage.^{13, pg. 4} Under this plan, prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP.^{13, pg. 4}
• 119SEIU Greater New York for New Jersey Fund. Covered members may receive mental health, behavioral health, or substance abuse services from a participating provider at a $10 copay per visit for outpatient services and 15% coinsurance for inpatient services.^{13, pg. 4} If you see a non-participating provider, there is no coverage.^{13, pg. 4} Under this plan, prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP.^{13, pg. 4}
• 1199SEIU National Benefit Fund for Home Care Employees. Under this Fund, there are two types of plans:
  • 1199SEIU National Benefit Fund for Home Care Employees – Plan A. Covered members may receive mental health, behavioral health, or substance abuse services from a participating provider at no charge for outpatient or inpatient services.^{14, pg. 4} If you see a non-participating provider, you could be charged for the remaining amount above the Fund’s coverage.^{14, pg. 4} Under this plan, prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP.^{14, pg. 4}
  • 1199SEIU National Benefit Fund for Home Care Employees – Plan B. Covered members may receive mental health, behavioral health, or substance abuse services from a participating provider at no charge for outpatient services or through a $25 copay per visit for inpatient services.^{15, pg. 4} If you see a non-participating provider, you could be charged for the remaining amount above the Fund’s coverage.^{15, pg. 4} Under this plan, prior authorization is required for non-emergency rehab admissions, as well as PHP and IOP.^{15, pg. 4}
• 1199SEIU Licensed Practical Nurses Welfare Fund. Members who need mental health, behavioral health, or substance abuse services and have this benefit plan do not have coverage for inpatient or outpatient services.^{16, pg. 4}

Check 1199SEIU Insurance Coverage for Rehab

Depending on the 1199SEIU Insurance plan that you’re a part of, you may receive coverage for treatment for addiction. American Addiction Centers (AAC) is here to help you learn more about your specific plan’s benefits and coverage. They can even help you verify your insurance coverage for you via phone call or via the benefits verification form below. By inputting your insurance information below, you can instantly see whether providers near you are in-network or not.

If you’re ready to take the next steps toward recovery, AAC is here to help. Call the AAC helpline and speak to a real person today.