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<br />I') <br /> <br />Amendment <br /> <br />AvMED <br /> <br />HEALTH PLANS <br /> <br />Mental Health Services <br /> <br />As of the effective date, outpatient and inpatient mental health services are covered, when Medically <br />Necessary, subject to the following Member cost sharing responsibility: <br /> <br />I <br />10 <br /> <br />. Outpatient mental health services are covered subject to the Member's cost sharing responsibility <br />for specialist services, <br />. Inpatient or partial hospitalization for mental health services is covered when a Member is <br />admitted to a Hospital or Health Care Facility, Coverage is subject to the Member's cost sharing <br />responsibility for inpatient Hospital Services. <br /> <br />Prior authorization is required for mental health services. Please consult the Schedule of Benefits for <br />Member cost sharing responsibility and Deductible information, if applicable. For further information, <br />contact A vMed at 1-800-882-8633, <br /> <br />A V-CHOtCE-MHPH-09 <br />MP-5297 (10/09) <br />