Mental Health Insurance Benefits

The U.S. Department of Health & Human Services reports as many as 30 percent of the population, ages 15-54, suffer from a mental disorder. Workforce statistics show those affected are three times more likely to miss work than other employees. As such, mental health insurance benefits work to minimize absentee rates, as well as enhance overall productivity within the workforce.

Identification

• Mental health insurance benefits are used to cover health-related issues that are psychological in nature. Treatment for mental or emotional problems, as well as substance abuse treatment, are included under these benefits. Coverage under these plans will vary according to state laws, and employer offerings. Typically, coverage for mental, or emotional issues is less comprehensive than what's provided for medical-related ailments. As such, coverage amounts will be less, and deductibles and copay requirements will be higher.

Types

• Mental health benefits are covered under standard health insurance plans. As much of the health insurance industry falls under the managed care umbrella, so do mental health benefits. The four plans available include Fee-for-Service (FFS), Health Maintenance Organization (HMO), Preferred Provider Organizations (PPO), and Point-of-Service plans (POS). FFS plans allow patients a choice in selecting their healthcare provider, whereas HMO plans require patients to choose from providers within a select network. Both FFS plans and PPOs pay a fee for each service performed, while POS plans and HMOs are based on a yearly benefit cap, and a select group of covered services.

Features

• The services provided under mental health benefits may vary depending on state requirements and employer offerings. Once a person has been diagnosed, referrals are made based on the needs of the patient. Possible provider types may include a primary care physician, a case manager, a social worker, a therapist, a psychiatrist or a registered nurse. At the start of treatment, a comprehensive assessment is done to determine which providers will best meet the needs of the patient.

Insurance Parity Laws

• Today's fast-paced work environments have put increased amounts of pressure on employees. As a result, the increase in depression and anxiety-related conditions has become an area of growing public concern. In an effort to meet these treatment needs, insurance coverage benefits have made provisions for insurance parity, which is fair coverage for mental health disorders that's comparable to medical coverage benefits. Insurance parity laws provide standardized cost models, coverage requirements, provider access, and treatment process protocols.

Parity Law Provisions

• Employer health insurance benefits are only subject to parity law provisions if they opt to offer mental health and substance abuse coverage along with medical coverage. These provisions vary from state to state, meaning different coverage amounts, services, and duration of treatment periods apply. As of October, 2008, a new federal law called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was enacted to extend coverage for mental health benefits not covered under current state laws. This law officially becomes effective as of January, 2010.