Mental and physical health conditions get equal out-of-network coverage

Enrollees in the Federal Employees Health Benefits Program finally will have their mental health care covered at the same level as all other medical conditions, thanks to changes enforced by the Office of Personnel Management.

Mental and physical health benefits have been at parity for in-network care since the Clinton administration, but patients seeking treatment with out-of-network providers had higher co-pays and were allowed limited visits. The 2008 Mental Health Parity Act, which takes effect in January 2010, strengthened a 1996 law by eliminating the disparity between out-of-network mental and physical health coverage.

In Blue Cross Blue Shield's Standard Option, FEHBP's largest plan, enrollees paid 30 percent of the cost for out-of-network medical care but 40 percent for mental health care in 2009. They were allowed only 25 visits for mental health conditions. In 2010, enrollees will pay 35 percent across-the-board with unlimited visits. In-network benefits for mental and physical care have been and will remain equal.

Enrollees should do their research before taking advantage of the new out-of-network benefits, according to Walton Francis, author of the Consumers' Checkbook 2010 Guide to Health Plans for Federal Employees. The challenge, he said, is some plans might favor a combination of medication and group therapy over individual sessions, or limit the length of in-patient stays.

Treatment plans do not qualify for coverage unless a medical professional deems them necessary, said Nancy Kichak, associate director for strategic human resource policy at OPM. "If it's found that it is equally or more effective to use the counseling route rather than admit to a facility, that's the way to go," she said. She added OPM has an appeal process for patients whose plans dispute a treatment's necessity. Patients also can seek opinions from multiple professionals because there is no limit on the number of visits. OPM still encourages enrollees to use in-network providers for all benefits.

To best understand these changes, patients should speak to their physicians and other providers, Francis said. Enrollees also can find information on the Consumers' Checkbook and OPM Web sites. While there is no comparison tool specifically for mental health coverage, each plan brochure contains a special section on mental health and substance abuse benefits.

In addition, several health plans are expanding coverage for childhood obesity preventative care. BCBS plans offer four free nutritional counseling sessions with a preferred provider for qualified children in the Jump 4 Health education program. Both the Rural Carrier and Mail Handler plans cover an annual body mass index testing for enrollees ages 2 to 21. But medical care coverage is not the only answer to lifestyle changes, Kichak said. "OPM is looking at this not just from a health insurance perspective, but also whether agencies in their Healthier Feds campaigns and workplace efforts can't do more on-site for their employees," she said.