Prime Health Services Insurance Coverage for Mental Health and Therapy

Prime Health Services Insurance offers behavioral health coverage that supports both mental health conditions and substance use disorders. Coverage details vary by plan type, such as HMO, PPO, or EPO, but most plans include both inpatient and outpatient behavioral health benefits. Inpatient coverage typically applies to medically necessary psychiatric hospitalizations, including treatment for mental health or substance use crises. Prior authorization and in-network facility use are generally required for inpatient treatment.

Outpatient behavioral health services are also a standard component of Prime Health Services Insurance plans. Members can usually access therapy, counseling, psychiatric evaluations, and medication management through in-network providers. Coverage often includes both individual and group therapy sessions, as well as treatment for co-occurring substance use disorders. Many plans also support telehealth or virtual behavioral health visits, allowing members to meet with licensed professionals remotely. These virtual visits are typically covered under the same cost-sharing structure as in-person care, unless otherwise stated in the plan.

Each year, Prime Health Services publishes updated member documents, such as the Summary of Benefits and Coverage, Evidence of Coverage, and provider directories, that explain behavioral health benefits in full detail. These materials outline copays, coinsurance, visit limits, and prior authorization requirements. Because plan designs and coverage details can differ, members are encouraged to review their current plan documents carefully to understand how behavioral health benefits apply to their specific coverage.