Better mental health benefits on tap for 1998

The Office of Personnel Management recently began the process of determining the makeup and rates for 1998 federal health insurance plans by issuing its annual "call letter " a guidance sent to health plan carriers that sets forth goals and procedure changes for the year. This year's call letter brings with it good news in the form of improved mental health benefits but bad news with the expectation of higher premiums.

The letter informed health plan carriers that participate in the Federal Employees Health Benefits Program (FEHBP) that all annual and lifetime dollar ceilings on mental health benefits for the 1998 plan must conform to the same ceilings that apply to other health benefits. This action is long overdue and it is good news for federal employees who need psychiatric or psychological counseling on a regular basis.

Most plans have severely limited the benefits payable for such services treating those who are afflicted with mental health problems like second-class citizens.

A stigma associated with mental illness still permeates our society. Because of this mindset health benefit plans have discriminated against the mentally ill and gotten away with it.

The irony is that most health plans have limited benefits for mental health services at OPM's request as a way to manage and control their premiums. Now OPM has reversed its position. Although the agency maintains that its action will not affect health benefit premiums I would not bet on it. It is going to be next to impossible for carriers to avoid raising premiums while increasing benefits. Of course carriers can decrease costs by cutting benefits for other medical problems. But I doubt OPM would favor such an approach federal employees certainly would not.

Whether this is good news for all federal personnel depends on your perspective. Years ago when federal health benefit plans did not limit mental health benefits some employees took advantage of that situation by visiting a therapist on a weekly basis for reasons that probably were not medically necessary.

In one instance an individual seeking psychiatric or psychological help may not have a "medical problem" that must be covered by a health benefit plan. The individual may benefit from counseling or therapy but the individual is not "ill." But in another instance a person may suffer from a panic disorder and urgently require psychiatric intervention.

The question is how do you tell these situations apart? Psychiatrists not wanting to see their incomes decline always will certify the medical necessity of their treatments. That is why many carriers curtailed their mental health benefits in the first place when OPM pressured them to keep premiums down. OPM must have approved of this approach. Otherwise health benefit plans would not have been permitted to limit mental health benefits.Now that health benefit plans no longer can discriminate against those obtaining mental health benefits the plans must either raise premiums cut benefits or do both. Not a very good set of options is it?

-- Bureaucratus is a retired federal employee who contributes regularly to Federal Computer Week.


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