Mental health

You might be surprised to learn that nearly 1 in 3 Nova Scotians struggle with mental health. That’s roughly 300,000 people out of a million strong! 

What’s more alarming is that a large portion of those who need mental health services have no access to them or are unable to afford them, as their mental illness isn’t covered by government programs.

As such, many Nova Scotians opt for private health insurance plans. Plans like Complete Health by Medavie Blue Cross allow individuals and businesses to customize coverage to best meet their budget and medical needs, both physical and mental.

As mental health becomes an increasing concern, it is now more essential than ever to have comprehensive mental health coverage structured into your health plan. This article discusses how you can do this, what to look out for, and what strategies work best for your specific medical needs.

Key Takeaways

• Mental health coverage in Canada is underfunded by 22% compared to its medical/surgical peers. 
• Most Canadians rely on out-of-network care for mental-health services, usually at much higher costs.
• Even when covered, many Canadians face structural (access) and attitudinal (stigma) barriers to care.
• Structuring a mental health plan requires clarity around parity rules, strong in-network access, digital options, and a mix of preventive and reactive care and support strategies.

Why Structuring Mental-Health Coverage Matters

Mental health illnesses can be just as damaging as physical illnesses. For many, it is a medical need that requires the same level of care, if not more.

However, many health insurance plans don’t treat mental health the same. Unlike physical health, mental health coverage often has more restrictions, weaker coverage, and higher cost-sharing.

As a result, many Canadians delay care or try to deal with mental health problems on their own, which is far from ideal and sometimes downright dangerous.
Having a well-structured health plan means having mental-health benefits that are comparable to physical-health benefits. This is referred to as mental-health parity, and when it works, it supports trust, retention, and well-being. Here’s how you can make sure your plan has it!

How to Structure Mental Health Coverage in Your Health Insurance Plan

1: Do Your Research

There are numerous health insurance providers in Canada, so it pays to shop around. Look for plans that have many types of consistent treatment coverages, such as long-term therapy, counselling, psychiatric treatments, addiction help, and even hospitalization coverage in case of more serious conditions.

While Federal and provincial parity laws require mental health benefits to be comparable to physical health benefits this isn’t always the case. Many health plans still have hidden non-quantitative treatment limitations (NQTLs), like prior authorization rules that differ, step therapy requirements, reimbursement delays, and restricted provider networks, which can make care hard to access. 

Doing your research and shopping around gives you the best chance of finding a plan that is closest to your needs and budget, whether for yourself or your employees. 

2: In-Network vs Out-of-Network Access

Unfortunately, many behavioural-health providers aren’t part of insurer networks. This is largely because reimbursements are often low and administration costs high, which makes being part of multiple networks less worthwhile for smaller clinics. 

This limited in-network participation means that patients often have to opt for out-of-network care which obviously costs more. 

You are thus left with a choice, pay higher out-of-pocket costs or endure longer wait times or dropped care plans by an in-network clinic near you. 

But this doesn’t always have to be the case.

Structuring a plan that offers a broad provider network, or includes your preferred mental health professionals can mean the best of both worlds; lower out-of-pocket costs and minimal wait time. 

Plans that include digital mental health platforms and culturally-competent specialists can also help make seeking help a lot more accessible and pocket-friendly.

3: Understanding Cost Structures: Deductibles, Copays, and Maximums

Health insurance plans often have different cost structures. When comparing plans, weed out ones where mental-health copay is much higher than your general-medical copay. These plans essentially signal “mental health is second-class.”

Instead, look for plans that ensure cost-sharing for therapy, counselling and/or behavioural services that mirror that of general-medical care. 

Keep an eye on deductibles too. Deductibles is the amount of money you will have to pay before your insurance provider starts helping with the costs. The lower the deductible amount the better.

You should also consider annual-maximum caps. If you think you may need long-term support the last thing you want is a plan where you hit your reimbursement limit too quickly. This will cause you to drop off the plan and bear the full cost of care.

4: Telehealth and Virtual Mental Health Services

A lot to do with why people don’t seek help when struggling with mental health is because of stigma. People worry about being judged, feeling misunderstood, or are simply afraid to open up to someone they don’t know. 

Teletherapy, online modules, and virtual check-ins can help address these structural and attitudinal barriers. Going to meet someone in person is a lot more intimidating than hopping on a virtual call while in the comfort and safety of your home. 

Telehealth and virtual mental health services have also made it possible for folks in remote parts of Nova Scotia to get the help they need. Virtual care helps cut down travel time, increases accessibility and reach, and lowers cost. It’s a win-win solution as long as these digital platforms meet clinical and privacy standards and are part of your in-network coverage.

5: Preauthorization Requirements and Treatment Duration Limits

Some plans come with preauthorization requirements. This means that you have to get an approval from your insurance provider before opting for a mental health treatment. Although not ideal, if your plan does include preauthorization requirements make sure you understand them fully so you can get the coverage you need.

You should also take the time to review any limits on your coverage. Most plans often have limits to how many therapy sessions are covered, or how many days you can spend at a mental health hospital or rehab center. This may not seem significant now but it could be in the future. Making sure you have a clear understanding of your plan’s limits can help you structure a health plan more effectively.

6: Range of Coverage for Mental Health Coverage and Prescription Drugs

Always look for plans that offer coverage for a wide-range of mental health conditions, including common ones such as depression, stress, and anxiety, and less common ones such as identity disorders, bi-polarism, and PTSD. It doesn’t matter if you have been diagnosed with any of these conditions or not, having a wider net of coverage means you are more prepared for whatever may come.

It is also important to check whether your health plan covers prescription medication for mental health illnesses. Having coverage for psychiatric medication, for example, is essential, as these medications can be extremely pricey. Compare plans to see which ones offer the widest range of coverage for your budget and needs.

Consult With Pat McIver – Your Trusted Nova Scotian Health Insurance Broker

Structuring a mental-health benefits plan isn’t a compliance formality, it’s a strategic move that can safeguard you and your family’s future.

A carefully thought out plan that offers parity compliance, a strong provider network, digital care, and proactive reach makes a real difference when it comes to handling access issues, cost, and culture disparities and perceptions.

To get the best guidance, advice, and long-term assistance call now at 1-902-220-3279 or click here to book a FREE 30-minute meeting with Pat Mciver – Halifax’s most trusted insurance broker.

FAQs

Q1) What is mental-health parity and why does it matter?

Mental-health parity means having a health insurance plan that covers mental-health services on the same terms as physical health. This matters as mental well-being is becoming a growing concern amongst Nova Scotians.

Q2) Why do so many providers stay-out-of-network?

This is because, as of right now, reimbursement for mental health costs is low while admin costs are high. This makes it less worthwhile for smaller clinics to be a part of the in-network. 

Q3) Can I cover mental-health services via telehealth?

Yes, many plans include telehealth services. Virtual care helps overcome geography, stigma, and cost-barriers making mental health services more accessible to everyone.

Q4) What are non-quantitative treatment limits (NQTLs)?

There are hidden rules like “you must try X before Y” or “extra approvals” that limit mental-health access even when coverage seems available.