Kaiser Permanente Birthday Billing (Employers with fewer than 50 employees)

When a Kaiser Permanente member has a birthday and moves from one age bracket into the next bracket, the rate will change on the next billing cycle for the group. For example a 54-year old employee moves from 50-54 to 55-59 bracket. Currently employees that have a birthday mid plan-year change age brackets upon renewal. This applies to small group employers with less than 50 employees.

Kaiser Permanente will make this birthday billing change effective on January 1, 2009 for new groups and existing groups renewing in January. This will be implemented on existing groups as they renew in 2009. Starting in April, employers will see a Flag on the bill to easily identify the members who change age brackets.

IRS Announces Indexed Limits for 2009

The IRS has announced the 2009 indexed dollar limits applicable to qualified retirement plans. This update is provided for informational purposes to Thoits Insurance's retirement plan clients and is not intended as legal advice.

Mental Health Benefits Help Employers Save on Medical Costs

The current debate surrounding the Congressional mental health parity bills gives us an opportunity to take a closer look at mental health benefits. Forty-six states have some form of mental health parity law, which require group health plans to provide mental healthcare benefits that are equivalent to those for medical and surgical care. Why are mental healthcare benefits important enough for all this legislative action?

According to the National Institute of Mental Health, 22 percent of adults in the U.S. suffer from a diagnosable mental health disorder. Yet only a third of the millions of Americans who suffer from a mental health disorder receive treatment. Because mental health has a strong effect on physical health, employers will want to consider the level of mental health benefits their plans offer.

The mental-physical connection.. The most common mental health disorders that arise in the workplace are anxiety and depression. Yet mental problems often present themselves as physical problems, and employees are more likely to seek assistance for a physical problem.

Studies have shown that if workers don’t get the mental health services they need, they use a lot of other services they don’t need. A medical doctor may not be able to determine what is wrong with a patient and will do a battery of expensive tests because he/she doesn’t want to miss anything. The end result? Physical healthcare can cost a whole lot more when mental healthcare is not available.

The productivity factor. When employees have ready access to good mental health benefits, they are less likely to be out on disability leave. Employees on behavioral health disability tend to stay out longer than those with any other condition, says the Society for Human Resource Management. And workers in plans with high deductibles, preexisting condition exclusion periods or “carve-out” programs that provide separate mental health coverage are less likely to return to work after suffering a mental disability, according to an analysis by Johns Hopkins University.

Untreated behavioral illnesses can have other consequences as well. Not only can productivity drop, but mental illnesses such as depression also can compromise employee safety. Experts urge companies to look at the whole picture. While decreasing coverage may save money in the short term, if disability claims skyrocket and employee turnover surges as a result, those savings will be minimal in comparison.

How do you know if your plan isn’t making the grade? Experts cite the following signs — and risks — of inadequate mental healthcare benefits:

• Limited number of therapy sessions. Even where a plan covers therapy, it may place arbitrary limits on the number of sessions allowed. Removing these limitations allows the therapy to work most effectively, preventing more serious problems — and higher costs — later.
• Limited choice of providers. Since a good relationship with a mental health provider is crucial for treatment success, participants need plenty of choices. The plan should allow visits to out-of-network providers for slightly higher out-of-pocket costs. The network should also include a sufficient number of experienced mental health specialists to deal with a wide range of disorders.
• Difficult access. Employees may be reluctant to seek needed mental healthcare because of a perceived stigma attached to behavioral illnesses. Employers can reduce that risk by making access to benefits quick, simple and confidential.
• Medication-only coverage. Employees routinely obtain medications from their primary care physicians under their prescription benefit. But they may not receive the best medication in the proper doses from non-mental health specialists. Studies show that a combination of medication and therapy is often the fastest way to recover from mental illnesses.
• Diagnoses from non-psychiatric professionals. Without the correct diagnosis, an employee cannot obtain the most effective treatment. An employee with a significant emotional problem should be evaluated by a psychiatrist or psychologist, who can determine which psychotherapy or medication is appropriate. Doing it right the first time saves money down the line.

For assistance in evaluating your company's mental healthcare benefits, please contact us.