According to a recent study by Mental Health America, about fifty million Americans are experiencing some kind of mental illness. Each year, major depression affects more than 8% of about twenty-one million American adults. No matter a person’s origin, age, status, line of work, or other personal characteristics, mental illness can affect anyone. Whether or not you know it, some of your employees are currently experiencing mental health problems.
Joann Mundin, MD
Employers should foster a positive work climate where staff may perform at their highest level and take pride in their accomplishments. Giving employees access to health insurance to address concerns about their mental health or usage of drugs is one way to foster a positive work environment. Making these decisions in advance will allow for changes to health insurance coverages. Then, you can make modifications to ensure your insurance provides enough coverage for mental health.
Legislation Regarding Mental Health Insurance Coverage
Health insurance programs generally cover services for behavioral and mental health. Regardless, it’s always a good idea to confirm the coverage specifics. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 was created to compel insurers to treat mental health treatment equally with treatment for physical health issues.
What Fundamental Change Was Introduced in MHPAEA in 2008?
Large group health plans were prohibited by the Mental Health Parity Act of 1996 (MHPA) from placing annual or lifetime dollar restrictions on mental health benefits that were less favorable than any such limits on medical/surgical benefits. The MHPAEA maintains the MHPA provisions and adds additional protections, the most important of which is extending the parity criteria to substance use disorders.
What You Should Know About MHPAEA
MHPAEA mandates that insurance providers refrain from placing additional restrictions on addiction or mental health therapies that are less favorable than the restrictions on other healthcare services. For instance, if sessions for other health concerns are not restricted, an insurer cannot impose a cap on the number of counseling sessions reimbursed. Copayments for mental health services have to be comparable to those for other specialized services, such as inpatient care.
Benefits of the Affordable Care Act
According to the Affordable Care Act, mental health problems are covered by all health plans on the government-run health insurance marketplace. Additionally, the ACA forbids insurance providers from refusing coverage due to pre-existing diseases and mandates that they provide preventative care. Most employer-sponsored health plans comply with the ACA and provide coverage for mental health care.
Accessing mental health care can get complicated due to factors like:
- Long waits for appointments for intake
- Lack of in-network medical professionals in the employee’s area
- Being unable to leave work to attend appointments
- Appointments with high copayments
- Hospitalization or inpatient care is unaffordable due to high deductibles
Examine the group insurance plans you intend to provide and any additional prescription drug benefits to be sure that cost won’t be a barrier to receiving care. Training managers and human resources professionals should be considerate of employees who require time off to obtain mental health or drug abuse treatments.
Why Is It Essential to Provide Your Employees With Mental Health Coverage?
Employees are more vulnerable to burnout or other mental health issues with the regular job and life changes brought on by the pandemic. Employees who are experiencing mental health issues are probably less focused and less involved with their coworkers and their work, and their productivity at work may suffer as a result. You want your staff to be able to meet your expectations for efficiency, work quality, and customer service. The majority of employees want to live up to those standards as well. Still, occasionally they want extra support to make sure they are in the correct frame of mind to complete their personal and professional duties. This is where various mental health therapies like psychotherapy, medication, and outpatient care come into play.
Employee dissatisfaction can also hurt your company’s culture as a whole. When a small subset of employees is unhappy, it might spread and lead to other workers losing interest in their work. Although mental disorders like depression or anxiety are not contagious like the flu, they might cause a lack of involvement or unfavorable attitudes toward the firm if left untreated. Promoting a great culture also involves demonstrating your concern for your employees through your benefit plans. An investment in your workforce and organizational culture is improved health insurance, including mental health care for your personnel. It is important from both a business and a personal standpoint. You should do your best to prevent insurance coverage from adding to the stigma around mental illness and substance misuse, which makes it difficult for people to access mental health care.
How to Make Sure That Your Employees Have Access to Mental Health Care
You want to make it simple for your staff to get mental health care. Consider these when you’re thinking about mental health care:
Review documents related to health care – Look at the health insurance plans you are currently providing. Do all of them offer coverage for mental health services? Do the available programs in your area offer adequate in-network behavioral healthcare providers? Do you provide at least one plan with affordable copays? Companies routinely offer plans with low monthly premiums but large deductibles and copayments; these are ideal for workers who do not frequently utilize healthcare services. However, plans with smaller copays and somewhat higher premiums are typically better suited for employees who need services like weekly therapy sessions, routine psychiatrist visits, and ongoing medication. You want to offer your staff insurance options that they can genuinely afford to use. Pay close attention to your deductible, inpatient treatment expenses, and copays for mental health appointments.
Should you go with HMO or PPO? It is hard to choose between HMO and PPO plans because each has advantages and disadvantages for the insured. There may be employees who would prefer the choice to join an HMO if your company is operating in an area where HMO health systems are standard. However, you should make an effort to avoid presenting an HMO as the only choice.
Pick a PPO if you must stick with a single insurance company or plan. The choice of healthcare providers is more flexible with PPO insurance, and recommendations are often not necessary to see a mental health professional. This is crucial for persons seeking mental health services because successful mental health treatment depends on the patient locating a therapist, psychiatrist, or institution they feel at ease. One system, and its particular set of treatment practices, cannot meet everyone’s specific needs in a field as complex and personal as mental health, so it is somewhat understandable that some large HMO healthcare systems have come under fire in recent years for the quality of their mental health services.
Can an employer refuse to hire or fire candidates or employees for mental health issues? Because a person has a mental health issue, an employer cannot mistreat them. This includes firing, refusing a job offer, a promotion, or requiring them to take time off.
An employer is not required to employ individuals who represent a “direct threat” to safety or hire or maintain workers in positions they are unable to fulfill. However, when determining whether a person can do the job or if they constitute a safety risk, an employer cannot base their decision on misconceptions or preconceptions about their mental health condition. Before denying employment due to a medical condition, an employer must prove that a person cannot perform the essential functions of the position or pose a serious risk to others’ safety.
The importance of employee assistance programs – Employee assistance programs (EAPs) are becoming more and more common as a means of helping employees, including support for addiction recovery and mental health care. EAPs facilitate access to expert assistance for mental health issues, addiction rehabilitation, legal aid, and directories for finding child and eldercare services. EAPs frequently cover a small number of employee counseling sessions. These programs are an excellent approach to offer additional help, but they should not be used in place of comprehensive mental health coverage under your employer’s health insurance plans.
Closing Thoughts
One of the most crucial actions you as an employer can take to encourage employee wellbeing in the workplace is to offer proper mental health insurance coverage. You should create a welcoming and supportive work environment and encourage staff members who need support to seek treatment from mental health professionals. Employee access to mental health care can also be aided by providing flexible leave and time off policies, EAPs, and an atmosphere of open communication.
Joann Mundin, MD, is a board-certified psychiatrist who has been in practice since 2003. She is a Diplomate with the American Board of Psychiatry and Neurology and a Fellow with the Royal College of Physicians and Surgeons of Canada. Currently associated with Mindful Values, she provides assessments and treatment for patients with severe mental illness. For more information, email dr.mundin@mindfulvalues.org.
