Over the last 25 years, coverage provided by employer-based group health insurance plans for mental health and addiction treatment has improved, partly because of legislative efforts pushing insurers and self-funded plans toward parity. More recently, as companies work to attract, retain, and support their workers, they have done more than simply comply with legal mandates by creating and offering programs to nourish their employees’ mental well-being. At Taylor Benefits Insurance, our consultants are ready to answer any questions you have about enhancing your benefits or ensuring that you can adequately document parity, if applicable.
Before the passage of the Affordable Care Act (ACA), parity for mental and behavioral health assistance was required for group health care plans by the Mental Health Parity and Addiction Equity Act, which was implemented in 2008. While MHPAEA did not demand that employer-sponsored plans include such benefits, it stipulated that if offered, they must be no less restrictive than the medical coverage in the program.
For example, if a health care plan charged a $25 co-pay for most office visits, then the MHPAEA stipulated that the co-pay for a mental health or substance abuse service should also be $25. If you pay $25 to visit a dermatologist, you should not pay $100 to consult a psychiatrist. Similarly, the act required that deductibles count toward either medical/surgical or mental health/substance use services, rather than the previously common practice of having separate deductibles to satisfy. Finally, it required that similar services be covered. If a plan covered inpatient medical care, it would also include inpatient mental health or substance care services, not just outpatient.
The MHPAEA—considered almost revolutionary at the time—was built on the foundation of the 1996 Mental Health Parity Act, which enacted limited parity requirements that established a rule for equivalent lifetime or annual limits for mental health and substance abuse treatment to those allowed for medical and surgical therapies.
The ACA extended the reach of the MHPAEA to market-based plans and included mental health and substance abuse as one of the ten Essential Health benefit categories that eligible plans must cover. In addition, the ACA’s prohibition on excluding people from coverage due to pre-existing conditions expanded the reach of the MHPAEA by eliminating exclusions for those with previous mental health or substance abuse histories.
However, despite parity requirements existing “on paper,” experts note that it is only recently that the rules have been provided with enforcement power via the 2021 Consolidated Appropriations Act, which requires employers to evaluate their compliance to ensure that they are providing equal coverage. The well-respected Society for Human Resource Management explains that the Department of Labor issued helpful guidance to assist employers and insurers in complying with the rules. Typically, employers rely on their insurers or third-party administrators to document compliance efforts.
Mental health awareness has become an increasingly visible concern for employers since the onset of the Covid-19 pandemic, and with good reason. There is widespread evidence that workers across all categories struggle with stress, anxiety, and depression. Research released by Limeade, an employee experience software company, reported that after the first six months of Covid adjustments, half of the employees surveyed had less energy, 42 percent lost interest in social activities, and had trouble sleeping. One-third were using more alcohol or other substances than usual. Managers continue to look for ways to counter the isolation of remote work, and some companies have boosted mental health benefits, at least temporarily.
In fact, according to the Kaiser Family Foundation 2021 Employer Survey, 39 percent of employers (with more than 50 workers) have improved their mental health services since the start of the pandemic. In addition, almost one-third increased how workers could access mental health resources, such as adding telehealth options, while sixteen percent added a new resource like an Employee Assistance Program. Other companies took a less formal approach and offered managers leeway to assist their teams with custom approaches, including suggested “mental health breaks” like online happy hour, activities designed to promote wellness and morale, and more.
While large employers are working to enhance their mental health offerings, employees are still dissatisfied with their access. In a study released by McKinsey & Company, seventy percent of full-time employees reported some level of difficulty accessing counseling services. For Generation Z (born in the late 1990s and early 2000s), that percentage rose to almost 80. That cohort also states that access to mental health resources is crucial for attracting them to an employer.
With more people working remotely and many preferring the privacy of an online interaction, companies see the wisdom of adding computer-based applications as options for access. Some are for evaluation and referrals, while others can directly link employees to therapy. Still others provide practical guidance in relaxation, behavior modification, sleep training, or other directed activities.
In some situations, apps can offer a convenient tool for employees, though certainly, the media is not appropriate for every mental health issue, and workers should have the option of in-person intervention. Well-known meditation app Calm offers plans for business with curated content and webinars for teams on topics including mindfulness and belonging, plus sleep support. Data on the Calm website states that 84 percent of Calm subscribers report improvements in mental health (when using the app at least five times per week), and 81 percent feel less stressed.
For current information and assistance with your benefit plan, contact Taylor Benefits Insurance.
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