QualCare Insurance Coverage for Rehab and Detox

Does QualCare Cover Rehab?

Yes. QualCare provides insurance coverage for rehab and detox. Due to the passing of the Affordable Care Act (ACA), all long-term insurance plans are required to include some level of coverage for mental health and substance abuse. The law considers substance abuse treatment an essential benefit.⁴ In addition to covering detox and rehab, the ACA requires insurance providers, like Qualcare, to provide insurance coverage for counseling,  psychotherapy, and other forms of addiction treatment.

Lastly, this law requires that all addiction treatment coverage be treated the same as medical coverage. That means that the deductibles and copayments you’ll be charged cannot be more than you would have for a medical procedure. The same percentage of costs should be covered for both types of care.

How to Check Your QualCare Rehab Coverage

There are several ways to find out more about how to use your Qualcare coverage for treatment. If you receive insurance coverage through your employer, you can contact your human resources department for information about specific rehab or detox coverage. They may be able to give you a phone number to contact the company directly.

You can also review your insurance coverage online. The My QualCare website allows members to log in and view their insurance information. You’ll see your recent insurance claims, plan information, premium, and more.

My QualCare also gives you access to provider information, allowing you to find a doctor or a hospital within the network.

Finally, you can also contact the company directly anytime between 8 am and 6 pm EST Monday through Friday. The customer service representatives will be happy to discuss your insurance plan and give you information about your substance abuse treatment options.

How to Find Rehabs That Accept QualCare

Qualcare is a regional subsidiary of  Cigna. Depending on your specific Qualcare plan, you may be afforded out-of-network coverage for rehab. However, if you have a plan that requires rehab centers to be in-network, your best bet is to look for rehab centers within Qualcare’s service network. Qualcare’s network includes over 100 specialty, acute, and rehab hospitals as well as over 40,000 other providers throughout New Jersey, Pennsylvania, and New York.² 

Types of QualCare Insurance Plans

Qualcare offers several types of health insurance plans with rehab coverage: ³

1. Open Access Plan: You coordinate your own care and do not need a primary care physician (PCP) or referrals. If you stay within the provider network, you’ll have most of your costs covered. However, you can also use out-of-network providers—you’ll just pay a higher deductible or copayment. You may need pre-authorization for some services.
2. Point-of-Service (POS) plan: members use a PCP to coordinate their medical care. They can use both in-network and out-of-network providers, but out-of-network care is much more expensive.
3. Health Maintenance Organization (HMO): plan requires a PCP as well. You need referrals to see specialists and you’ll have to stick with in-network providers. While this plan is a bit more restrictive, the monthly premiums are much less expensive.
4. Preferred Provider Organization (PPO) plan. This type of plan offers the best rehab coverage as well as the most options. As a result, this plan will cost more in monthly premiums. You pay less for in-network providers, but you can see out-of-network doctors if you’re willing to pay higher deductibles and copayments. You do not have to have a PCP, but you might need preauthorization for specific types of care.

QualCare does not offer Medicare or Medicaid plans directly, but you might be able to get that type of coverage from other Cigna subsidiaries.