Behavioral Health Treatment Copayment Checklist
- Most recent complete Federal 1040 Tax Form for family/individual (for clients age 3 and up only)
- Treatment plan from Behavioral Health Treatment provider.
- Information on the frequency of treatment (e.g. 5 days per week). Usually part of the treatment plan.
- Summary of Benefits for your health insurance that includes information on the plan year, copayments or coinsurance amounts, and out of pocket maximums for the individual.
- For plans with deductibles and coinsurance: copy of the billing statements/explanation of benefits from the health plan that indicate the deductible and /or copayments/coinsurance that is charged for Behavioral Health Treatment services