MENTAL HEALTH: BEYOND THE LIMITS OF CORPORATE INSURANCE

The following might sound overdramatic, but it is based on the real case:

It is Dec 5th, 2023. You are trying to book an appointment with a mental health specialist covered by your insurance online. You cannot believe your eyes; the next available appointment is Dec 6th!

You booked it right away. Relieved. You receive the confirmation; it reads, “Dec 6th, 2024.”

It takes a minute to register… a year from now.

Health insurance is an essential part of the employee benefits list, but it is also important to understand where the limits go. As a financial instrument, it is meant to help employees cover the costs associated with treating acute health-related ailments, so it serves as a soft safety net, but it is not a healthcare solution in itself.

Indeed, due to its legacy, strict regulations surrounding insurance, and its aim to provide provider-wide service coverage, this conflicts with the soft ambitions that employers have today, such as personalisation, employee engagement, and clear accountability in terms of ROI or other KPIs. But this is exactly what is needed for mental health cases: personalised assessment and support.

Mental health issues are not as “straightforward” as a broken arm. Some people are able to “keep up appearances” longer; stress will not affect everyone the same way or on the same timeline.

Being a financial instrument, corporate health insurance’s main focus is cost. It does not play a role in finding the right specialist, spreading awareness, and making sure employees are engaged.

We know well how and when to contact our GP or even secondary care specialist. However, lingering mental health problems often do not find a proper response, as people are not clear on how to seek help, and the vast number of barriers associated with it make us wait to overcome the issues all by ourselves.

Physical ailments and mental health issues manifest in very different ways and time frames. We have grown accustomed to somatic health services, but mental health issues need an adapted process.

But before we dive into that, let’s explore corporate health insurance.

What is Corporate health insurance?

A bit of History

Traditional health insurance in the workplace in Western countries emerged in the late 19th and early 20th centuries. It primarily focused on sick leave and pension plans. Scattered and uneven at first, it became more common and organized after the Second World War. Since then, it has kept evolving to include more and more coverage as society evolved and professional and personal lives got more and more intertwined.

While some countries make it mandatory for companies to offer health insurance, in others, it is not an obligation and is seen as an add-on or perk. There are several reasons why businesses may decide not to propose health insurance, from their size to already existing publicly funded schemes.

For people living in countries without national health coverage, corporate health insurance is the only way to make sure employees will have access to affordable or free care, and health insurance can become a real perk, depending on how much coverage the company decides to offer.

That is why it is an essential part of the Human Resources department’s role to ensure that the company stays on top of regulations and legislation around health insurance and mental health in your country and specific industry.

Pills & Money, the first image that comes up when search for health insurance. How can we change that?

Who is it for, and what does it usually cover?

Corporate health insurance ideally covers all employees. However, it usually does not cover freelance hires who should have their own insurance.

As we mentioned in the introduction, health insurance touches upon a highly regulated domain. They tend to cover what is called “clinical medicine,” the branch of medicine that deals with the diagnosis and treatment of diseases.

However, we know that the vast majority of mental health issues we face daily cannot be considered “clinical,” as they can be triggered by personal issues, relationships, work situations, stress states, etc., which are all outside of the scope of the traditional health care system.

Where insurance truly helps is that it gives access to doctors and specialists and covers the cost of procedures and treatments for new illnesses and accidents, with the employee having to pay only a small excess at times.

However, chronic and pre-existing conditions are, for the most part never covered.

This usually impacts mental health conditions which are really specific to the individual and the environment. They can also take longer to “cure” or are more prone to “relapse” in certain conditions, which makes Insurance companies reluctant to cover them.

How does it work?

That will vary from provider to provider. Sometimes the employee needs to ask for help. This can already be a stretch for some people, especially when it comes to mental health issues. If things are getting easier in that area, there are still frictions. For example, once you have met your recognised specialist, you will need to pay for the treatment or appointment yourself and then make a claim to your insurance which will investigate before granting reimbursement…or not.

This process can often feel quite rigid and lacking empathy, at a time when this is what one may need the most.

What are the limitations of professional health insurance?

While they are definitely essential and give access to care to people who could not afford it otherwise, health insurance companies are part of regulated financial system, which has an impact on the flexibility and scope of services that can be covered in the insurance.

Insurance covers clinical specialists – most users not yet in a clinical state

The insurance usually provides a list of health specialists they will cover and that list does not always include mental health specialists or other specialists.
Insurance will cover for conditions that have already “gone too far” and require treatments. This means that the employee is already suffering and at a stage where they might already be unable to keep working in some cases.

The admin and paperwork can be daunting and “expose” your condition to HR colleagues which the employee might not be ready to do just yet

The accredited specialists often have traditional office hours and face-to-face appointments which makes it difficult to be seen quickly. In addition, the traditional processes in place are not offering streamlined and frictionless experiences as we can expect in today’s day and age.

Corporate health insurance has a “curing” approach rather than a preventive. At the end of the day, corporate insurance is a financial support solution.

As a financial instrument, corporate insurance does not positively impact the culture of the whole company. It does not encourage employees to be more self-aware, feel more supported, and seek help and personal development.

Location Location Location: Health care is highly regulated and specific to geographical location. This makes it complex for modern teams that employ people around the world. This adds a layer of complexity for solutions like virtual consultations.

Coaching services are rarely covered.

Basically, with most health insurance, you always want to read the small prints.

At Siffi, we saw these challenges and decided to make them our strengths!

Siffi closes the gap.

We see health as a whole and we believe mental health is an essential part of the puzzle.

Our focus is on a more holistic approach to health.

If we refer to the World Health Organization depression and anxiety disorders cost the global economy about $1 trillion per year in lost productivity. That is definitely something we want to cover ourselves from. And at Siffi, we believe it can be prevented.

Financial Coverage vs Solution

As mentioned earlier, corporate health insurance are financial instrument covering mental health consultations amongst other issues within policy limits. It doesn’t address service delivery. While at Siffi we offer tailored mental health services ensuring quick access, increased self-regulation awareness, and impactful support to employees.

Being late vs On-time Support

The insurance primarily addresses clinical issues, at a pace that is often too slow when it comes to mental health, resulting in lost productivity for the company.

At Siffi we prioritize prevention and timely assistance. With easy access, personalized programs, and expert specialists, we ensure employees don’t face unnecessary hardships.

Referring vs Engaging

Insurance relies on self-referral, which can lead to high churn and unaddressed issues.

Siffi: Takes an engaging approach. Our programs raise awareness and guide individuals to the right level of care or tools, ensuring a seamless and relevant support experience.

Limited vs Global Accessibility

Insurance Coverage applies usually in one country only while Siffi is available globally, yet caters to localised and accessible services, understanding the specific needs of each individual team member.

Financial Support vs Well-Being Culture

Insurance focuses primarily on financial support, without necessarily contributing to a broader well-being culture in the workplace. At Siffi we actively work towards creating a well-being culture within the organization, fostering a supportive and engaged workforce.

Passive vs Proactive Partner

Insurance is almost like a passive bystander, only stepping in when something happens.

Siffi is your proactive partner, providing actionable insights for better decision-making and a more productive work environment.

We are also engaged in reducing stigma by working together with companies to impact the whole culture of the workspace rather than just the individual and introduce proactive and preventive actions and behaviors that will be converted into evidence-based results through the app.

Get support on your terms. In the comfort of your own home

We work for mental health never to be excluded again

Health Insurance is a vital part of any modern and thriving company.

However, it is important to keep in mind that not all health insurance is created equal, and can provide everything your team needs in the moment and for the future.

While traditional health insurance offers great financial help to many conditions, there is definitely a need for another kind of support, which can act as a proactive partner providing actionable insights for better decision-making and a more productive work environment.

Insurance fights the consequences of issues that have gone too far. Siffi builds a work culture that prevents going there.