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<br />) <br /> <br />Amendment <br /> <br />AvMED <br /> <br />HEALTH PLANS <br /> <br />Substance Abuse Services <br /> <br />As of the effective date, outpatient and inpatient substance abuse services are covered, when Medically <br />Necessary, subject to the following Member cost sharing responsibility: <br /> <br />. Outpatient substance abuse services are covered subject to the Member's cost sharing <br />responsibility for specialist services. <br />. Inpatient or partial hospitalization for substance abuse services is covered when a Member is <br />admitted to a Participating Hospital or Health Care Facility. Coverage is subject to the Member's <br />cost sharing responsibility for inpatient Hospital Services, <br /> <br />q <br /> <br />Prior authorization is required for substance abuse 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 />I I <br /> <br />AV-GIOO-SAPH-09 <br />MP-5298 (10109) <br />