Health Insurance Plans Must Account for Mental Health and Substance Use Disorder Treatment. Does yours?
magine your employee has a chronic illness – diabetes or Crohn’s disease, for example. You would expect the health plan you provide would pay for deductibles and copayments and other standard medical claims, right? Is it the same if your employee is experiencing anxiety or suffering from Substance Use Disorder (SUD)?
The Affordable Care Act and the Mental Health Parity and Addiction Equity require that health plans treat mental health and substance use disorders the same way they treat other health issues. That means your mental health and substance use disorder coverage must be comparable to coverage for general medical and surgical care. And limitations on mental health and substance use disorder benefits such as copayments, visit limits, and preauthorization requirements, must generally be comparable with those for medical/surgical benefits. Is your plan in compliance?
The fact is, somewhere between 5 and 17 percent of your employees suffer from substance abuse disorders (SUDs), depending on the industry you are in. From a financial perspective, businesses absorb a large portion of the cost associated with untreated SUDs – mainly healthcare costs and lost productivity due to absenteeism. Plus there are costs associated with the turnover of employees with SUDs who cannot maintain a job. According to the Center for American Progress, the average cost to employers for recruiting and training replacement workers is 21 percent of an employee’s annual salary. SUDs in the workplace also contribute to 65 percent of on-the-job accidents and somewhere between 38 and 50 percent of all workers’ compensation claims.
The Department of Labor offers helpful resources regarding mental health and SUD parity. And at Lionrock, we make it possible for employees to access private, affordable and effective treatment.
Here are some ways to support your employees with both mental health and substance use issues:
Promote the benefits. Too often, in fact more often than not, there is stigma attached to SUD and mental illness. Employers can play a major role in removing that stigma by creating parity between the general medical benefits they offer and the mental health benefits they offer. Currently, more than 20 million Americans need SUD treatment but don’t get it. And at least twenty percent of workers cite fear of stigma as the reason for not seeking help.
Remove barriers to access. In addition to promoting the benefits, employers should work to remove any real or perceived barriers to accessing them. For example, employers can remind employees that the U.S. federal government’s HIPAA regulations govern the privacy requirements for Substance Use Disorder treatment, as they do any provision of health care in the U.S. Under HIPAA rules, a patient’s “personal health information” must be private, and there are strict rules concerning how that information may be disclosed.
Educate employees. Employers can also provide information on what treatment might look like. There is a “continuum of care” in drug addiction treatment that spans the most intense levels of care through post-treatment recovery support. Ideally, clients progress from higher levels of care to lower levels, however, the best plans are built to the employees’ individual needs.
Health insurance plans must account for mental health and substance use disorder treatment. Make sure yours does. Want more information? Contact us.