What questions should we ask our Benefits Broker, TPA, or EAP?
According to a 2019 brief, more than half of Americans under age 65 — about 158 million people — get their health insurance through an employer. For people who rely on their employer for health care, the employer must ensure that their employees receive adequate health insurance coverage. Here are a few examples of questions you should be asking your benefits broker, TPA, or EAP:
Health Insurance
- Do our health plans have the same benefits and coverage limits between physical and mental health conditions?
- For the health insurance plans we offer, what is the percentage of behavioral health providers that are in-network and are currently accepting new patients?
- For the health insurance plans we offer, do you provide a comprehensive and user-friendly online behavioral health directory with a selection tool to help users access specific services?
- Can we be provided an up-to-date, accurate, and complete provider directory of mental health professionals who are accepting new patients?
- Do our health plans cover a variety of mental health services including home-based services or different types of outpatient care - including, for example, peer services?
- Do our health plans cover effective prescription medications for mental health conditions at a level that encourages their appropriate regular use?
- Do our health plans encourage mental health and stress management through a comprehensive wellness and health promotions program?
- Do our health plans track disability claims for mental health conditions and provide case management services to facilitate timely return to work?
- Do our health plans provide access to behavioral health providers in after-hours emergency situations?
- How quickly can an employee or dependent get an appointment in an emergency situation?
- Are the health insurance plans we offer accredited through NCQA MBHA or External Mental Health Parity Compliance Audit?
- Do our health plans reimburse for collaborative care in primary care?
- Do our health plans offer a care navigator to help our EAP or employee access timely in network qualified providers?
EAPs
- How can your program be an extension of our workplace culture rather than a separate entity?
- How can we work together to promote and educate our employees about the services you offer?
- Can you describe the experience of an employee who first interacts with your services until they no longer need the services?
- Do you provide regular and confidential utilization data, and can you make recommendations for how to apply what we learn from the data?
- How do you define utilization? Does utilization include web hits and event participation in addition to actual cases and consultations?
- What resources can you provide to our supervisors?
More Information:
How can we educate our employees about their benefits?
How can we promote our EAP to increase its usage?
How much is mental illness costing our workplace?
Resources:
References:
Health Insurance Coverage Eight Years After the ACA
Burn-out an "occupational phenomenon": International Classification of Diseases