May 28, 2025
Effective June 1, 2025, some of our members employed by counties, municipalities and fire protection districts may have coverage for mental health counseling services at no cost as required by Illinois SB 3538 (Public Act 103-1011).
To determine whether to collect cost share from your patients, check eligibility and benefits through Availity® Essentials or your preferred vendor prior to rendering care. This step will confirm membership and other important details, including coinsurance, copays and deductibles.
Members with high-deductible health plans must meet their deductible first.
For affected members with PPO plans, mental health counseling will be covered without cost sharing regardless of place of treatment when services are provided by these provider types:
- Clinical social worker
- Professional counselor
- Licensed psychologist
For affected members with HMO plans, mental health counseling will be covered without cost sharing when services are rendered by any behavioral health provider in office and outpatient settings.
Verification of eligibility and benefits information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Illinois. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.