Liz Sheffield

Employee Health Insurance Coverage for Alcohol Rehab

A healthy workplace benefits employers and employees alike. Good health can mean anything from avoiding the common cold to staying healthy during pregnancy. It can also mean recovering from addiction.

Employers should handle addiction recovery — including alcohol rehab — as a disease, with treatment options covered by an employee benefits package. Don’t forget that employee addiction has severe consequences not only for the individual and their family but also for the organization.

Trends and Regulations

“In the past, a third of private insurance plans sold on the individual market did not cover addiction treatment,” writes the New York Times. “Medicaid covered little besides inpatient detox. Now, more health care providers are offering and getting reimbursed for outpatient counseling and medications like Suboxone and Vivitrol, which have been shown to reduce the potential for relapse.”

While the Affordable Care Act contributed to a greater number of health care providers offering treatment services, depending on the situation, there are other federal regulations that address and protect employees seeking treatment for addiction.

As the U.S. Equal Employment Opportunity Commission notes, employee alcoholism — and, with some caveats, drug addiction — must be reasonably accommodated under the Americans With Disabilities Act. Example accommodations may include receiving time off for rehabilitation or to attend support group meetings.

Also potentially affording employees protection, substance abuse can also be considered a serious health condition under the Family and Medical Leave Act.

Employee Responsibility

Because of the variety of options available and the wide range of what is and isn’t covered, the onus typically falls on employees to be informed about the treatment available to them or to family members covered under their health insurance plan. Substance abuse treatment is covered under many health insurance plans, and as with any part of health coverage, it’s imperative for employees to carefully review plan details to understand exactly what and how much is covered.

Help your employees understand their plan’s requirements and conditions related to:

  • In-network physicians and facilities
  • The inclusion of detox as treatment
  • Length of treatment
  • Previous rehab treatment

Each plan is different not only when it comes to what’s covered but also in terms of deductible limits, copayments and rates of coverage for out-of-network providers. After they’ve reviewed plan documentation, encourage employees to confirm their understanding with a member of the HR department or the insurance provider to avoid any unexpected out-of-pocket expenses.

Communication and Awareness

To ensure that employees and their families are aware of alcohol rehab benefits and are confident in requesting to use the services they need, organizations must communicate frequently and openly about how to access these benefits as part of health insurance plans. Given the sensitive nature of addiction recovery, it’s essential to handle this communication strategy with a nonjudgmental and open approach.

Include information in benefits program messages throughout the year, making sure that it’s featured as part of your communication plan for open enrollment, new-hire onboarding and any news around changes or updates to the plan. Due to the social stigma around addiction, employees may be hesitant to ask questions about what the plan covers. If you or your health insurance carrier provide a confidential way for employees to inquire about health services, make sure that is clearly communicated.

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When employees are comfortable seeking the help they need, they’re more likely to get better. But recovery from addiction can be a precarious process, so make sure you’re opening — and leaving open — as many doors to success as possible.

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This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.