Benefit Plan Checklist
Employer benefit plans are a valuable tool to attract new talent or reward and retain existing employees. A best practice is to schedule an annual check-up to ensure your benefit plan remains healthy. Here are a few tips for aligning your benefit plans:
Health Benefits
Employers should ensure health plans include comprehensive behavioral health services for substance use disorder and mental health. Some of these behavioral services might consist of substance abuse prevention and intervention strategies. Educate employees on these behavioral services reflecting the company’s recovery friendly culture.
Understand how the plan will affect prevention, treatment, recovery, and telehealth services. Verify that the plan meets all the mental health and addiction equity (MHPAEA) requirements. Identify nearby outpatient and inpatient facilities included in the health plan’s PPO network to allow quick communication when events occur.
- If multiple options are available, seek out centers of excellence by looking at online reviews and other sources, such as Healthgrades.
- If no in-network options are available locally, please reach out to your benefits administrator or PPO network to engage providers.
Telehealth Services
Telehealth resources are being used more frequently today, allowing greater access to health care services. U.S. employers could save up to $6 billion per year by providing telehealth technologies to their employees. Engage with your administrator to understand if benefit services (i.e., mental health, substance use disorder, etc.) are available via telehealth. If available, identify the cost associated with these services or benefits.
Pharmacy Benefits
Engage with your benefit administrator to manage drug costs; here are a few tactics to consider:
- Prior authorization before filling prescriptions
- Quantity limits
- Step therapy, requiring less expensive drugs to be tried first
- Employee paying the difference between generic and brand costs
- Integrated medical and pharmacy data for more effective cost management
- Mandatory mail order for maintenance medications
- No co-pay for selected generic medications
Tactics focusing on specialty drugs:
- More aggressive use of management protocols for specialty medications
- Requiring specialty medications to be obtained through a specialty pharmacy
- Pharmacy plan designed with a specialty tier with greater cost sharing
Non-Drug Alternatives:
Employers using these alternative therapies can reduce the use of prescription pain medication that will impair performance and become addictive.
- Physical therapy
- Chiropractor
- Massage
- Acupuncture
Short-or Long-Term Disability
If offering short or long-term disability coverage on a voluntary or involuntary basis, confirm any pre-existing waiting periods or restrictions on behavioral health that are included in your benefits plan.
Outpatient/Inpatient Treatment
Employers should provide employees and their families with educational and training programs related to the use of these services under the benefit plan requirements.
Wellness Programs
Promote programs as a way for employees to stay healthy (exercise, eating habits, sleep patterns). Use awareness and education campaigns using social media and other tools to assist in finding helpful resources. By providing educational opportunities and enhancing awareness through discussion, organizations are de-stigmatizing the culture and environment of the workplace. Wellness programs designed to reduce anxiety, such as yoga and meditation, will help employees manage work-related stress, a leading workplace health problem.
Utilization Reports
Utilization reports will identify the waste and inefficiency in an organization’s benefit plan. By understanding these reports, organizational leaders can moderate the cost of health benefits by holding benefits administrators and other vendors accountable for meeting reasonable targets as opposed to shifting costs to employees.
Start conversations with administrators and vendors by:
- Requesting monthly and quarterly utilization reports
- Asking for specific information, preventative care, prescription claims, patterns in the data
- Asking detailed questions regarding claim data
Analyzing data can assist organizations in making changes in a health plan strategy. Here are a few tips:
- Plan ahead – Review the reports every month to identify any questionable adjustments.
- Changes – Is there a surge in the cost of services? Adjust the plan according to the claims.
- Educate – Use the data to educate your workforce on alternative avenues to reduce costs in claims on services and prescriptions.
Employers who provide comprehensive benefits advocate for better mental health in the workplace. In return, this will help create a positive work environment and reduce stigma around mental health and substance use disorder.
Employee Assistance Program (EAP)
The use of Employee Assistance Programs (EAP) averages below 10 percent, according to multiple studies, consultants, and human resource professionals. The Washington, D.C.-based National Business Group on Health, for example, found that median use in 2018 was 5.5 percent. (SHRM: HR Magazine-Winter 2019-Theresa Agovino-Companies Seek to Boost Low Usage of Employee Assistance Programs).
An EAP, along with education regarding the program, is a valuable workplace benefit. Education is necessary because the stigma surrounding substance use disorder (SUD) and mental health issues is a barrier when it comes to the use of an EAP. A large number of individuals who suffer from SUD are active in today’s workforce. Employees in the workplace that are struggling with SUD and mental health issues can negatively impact an organization’s bottom line. Employers can play a significant role in supporting employees and guiding them to long-term recovery through an EAP. This, in return, will impact an organization positively through its financial bottom line.
Organizations that offer an Employee Assistance Program will help remove barriers to treatment. An EAP provides employees with free and confidential services. Examples of services that employees can receive are counseling, referrals to treatment, and the support they need during and after substance use disorder or mental health treatment. There are many levels of care for SUD and mental health disorders. When an employee is clinically assessed for SUD, he or she can enter inpatient or outpatient care, which may include medication-assisted treatment. It is essential for employees who need treatment to receive the appropriate level of care. After employees complete treatment and transition back into the workplace, they must have a supportive work environment. Contact your organization’s benefits administrator about how to establish or implement an Employee Assistant Program to address your employees’ healthy well being.
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