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Does GEHA Cover Mental Health Counseling?

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Does GEHA Cover Mental Health Counseling

Mental health is just as important as physical health, yet seeking counseling or therapy is still stigmatized in many communities. The cost of treatment adds another barrier for people struggling with mental health issues. In this comprehensive guide, we’ll explore whether the GEHA health insurance plan covers counseling and therapy services.

We’ll break down GEHA’s coverage for different types of mental health providers and treatment settings. You’ll learn about copays, deductibles, and other out-of-pocket costs you may face. This will give you a clear understanding of GEHA’s mental health benefits to make an informed choice about using their plan for counseling services.

Let’s get started!

What is GEHA and who can enroll?

The Government Employees Health Association (GEHA) is a non-profit health insurance provider serving federal employees, annuitants, and their families. It’s considered one of the top plans available through the Federal Employees Health Benefits Program (FEHBP).

You can enroll in a GEHA plan if you are:

  • A current or retired federal civilian employee
  • A current or retired member of the uniformed services
  • A family member or dependent of one of the above
  • Receiving healthcare benefits through another federal program

GEHA offers plans nationwide, so you can use their coverage no matter where in the U.S. you live or travel. About 500,000 Americans currently have GEHA health insurance.

Does GEHA cover mental health counseling?

The short answer is yes – GEHA health plans do provide coverage for outpatient mental health counseling and therapy services. But there are some important details around what’s covered and any associated costs.

GEHA offers two main types of plans – High and Standard Options. Both plans cover mental health services, but the coverage and costs vary slightly between options. Here’s a breakdown:

High Option Plan

  • Outpatient counseling covered at 100% after $20 copay per visit
  • No limit on number of covered visits
  • No need for referrals

Standard Option Plan

  • Outpatient counseling covered at 80% after annual deductible is met
  • $20 copay applies once deductible is met
  • No limit on number of covered visits
  • Referrals not required

So in summary, counseling visits are covered benefits with low copays under both GEHA plans. The Standard Option requires meeting the annual deductible first. But there are no visit limits or need for referrals with either option.

What types of mental health providers are covered?

GEHA covers counseling services from several licensed mental health provider types:

Psychiatrists

Medical doctors who specialize in diagnosing and treating mental illnesses like depression, bipolar disorder, schizophrenia, etc. They can prescribe and manage medications.

Psychologists

Professionals trained in evaluating and treating mental, behavioral, and emotional issues through therapy and testing. Can’t prescribe medication.

Clinical Social Workers

Masters-level clinicians who provide counseling for various conditions using therapeutic techniques.

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Licensed Professional Counselors (LPCs)

Masters-level providers specializing in counseling through talk therapy. Treat conditions like depression, anxiety, addiction and relationship issues.

Marriage and Family Therapists

Professionals trained in counseling individuals and families through relationship or systemic issues.

So whether you see a psychiatrist, psychologist, clinical social worker or licensed counselor – GEHA covers these approved mental health professionals for counseling treatment. Just check that your provider is in-network for lower costs.

Are other treatment settings covered?

In addition to private practice outpatient counseling, GEHA also covers mental health treatment in several other key settings:

Inpatient Treatment

Both GEHA plans provide coverage for psychiatric hospitalization when medically necessary. The High Option covers 80% in-network after $100 copay per admission. Standard Option pays 60% after annual deductible.

Partial Hospitalization Programs (PHPs)

Intensive day treatment programs as an alternative to inpatient hospitalization are covered benefits. High Option pays 80% after $100 copay. Standard Option pays 60% after deductible.

Residential Treatment Centers

Live-in therapeutic programs for conditions like eating disorders, substance abuse issues and more. Both plans cover approved centers at regular inpatient benefit levels.

Telehealth Services

GEHA covers video or phone counseling sessions with in-network providers at the same benefit rates as in-person visits during COVID-19. May continue after pandemic ends.

So in a crisis, for intensive treatments or if transportation is an issue – GEHA members have coverage options beyond the standard outpatient office visit settings as well.

Do pre-existing conditions affect coverage?

No, GEHA does not impose any pre-existing condition exclusions on its mental health coverage. This means they cannot deny coverage or charge higher rates based on mental health issues you had prior to enrollment.

A few key points about pre-existing conditions under FEHB law and the Affordable Care Act:

  • All plans must cover mental health services regardless of pre-existing conditions
  • Conditions can’t affect your rates or benefits eligibility in any way
  • Coverage is available immediately upon joining a GEHA plan
  • No need to disclose mental health history on your enrollment application

So if you’re seeking counseling for an ongoing issue like depression or have a history of inpatient treatment – you’ll still qualify for GEHA’s full coverage benefits at standard premium rates. Pre-existing conditions won’t impact your access to mental healthcare.

Are there any limits on coverage?

Aside from small copays and deductibles, GEHA plans do not impose explicit visit limits or annual/lifetime dollar limits on most mental health services:

  • No visit caps on outpatient counseling or telehealth sessions
  • No limits for therapies like applied behavior analysis
  • No annual or lifetime dollar maximums you can receive

However, GEHA does reserve the right to conduct utilization reviews of certain high-cost or long-term treatments to ensure services remain medically necessary. If approved standards of care are exceeded without sufficient need, further coverage could be denied. But typical outpatient counseling does not face restriction.

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In rare cases, a required preauthorization may apply to services such as certain residential treatments, partial hospitalization or trans cranial magnetic stimulation. But wait times tend to be minimal. Your provider can easily obtain approval upfront, which GEHA approves over 90% of requests.

Overall, GEHA provides very generous coverage for long term and specialized mental health services compared to many plans – with minimal hassle for members seeking appropriate treatment. This allows for maximum coverage based on medical considerations rather than financial caps.

What costs will I be responsible for?

While GEHA covers most of the bill for approved mental health services, you are responsible for certain out-of-pocket expenses depending on your plan choice and type of treatment received. Here’s an overview:

High Option Plan

  • $20 copay per outpatient counseling visit
  • $100 copay per medical facility admission
  • 20% coinsurance for therapies, tests, procedures
  • $350/individual deductible, $700/family
  • $3,500 out-of-pocket max per year

Standard Option Plan

  • $20 copay once $1,000 deductible met for counseling
  • 60% coinsurance for approved facilities after deductible
  • $1,000/individual deductible, $2,000/family
  • $5,000 out-of-pocket max per year

So in general, expect a small copay for each counseling session or 20% of costs until deductible/max is met. Facility stays involve larger copays or coinsurance amounts. Note GEHA deductibles do not apply to counseling visits – just facility/provider costs over plan allowances.

Out of network coverage is also available for emergencies, but at lower 60-70% rates versus 80-90% in network. Costs are higher overall if providers don’t participate in the GEHA network.

Are there any exceptions to standard costs?

Yes, a few important exceptions may alter your out-of-pocket responsibility in certain circumstances:

  • Preventive care like annual depression screenings are fully covered with no cost sharing.
  • Inpatient treatments over 60 days receive 100% coverage to encourage proper treatment lengths without cost barriers.
  • Dependents under age 26 receive counseling benefits at 100% like primary care under the ACA.
  • Low cost generic medications receive 100% coverage in Tier 1. Brand name drugs are more.

So while a general overview is provided, it’s best to discuss specific treatment plans and costs with GEHA directly given nuances and available exceptions built into the plan design.

Is it easy to find in-network providers?

Yes, GEHA has contracted with a extensive network of eligible mental health professionals located nationwide to make counseling easily accessible wherever members live.

Some key points:

Over 700,000 providers participate across the U.S. through an agreement with the MultiPlan PPO network.

Members can search an online directory of providers by location, name, specialty and more. Filters ensure only in-network results appear.

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GEHA members also have access to telehealth options through Doctor On Demand and Amwell during the pandemic for virtual counseling or therapy from anywhere. This expands access considerably.

Transition of care is supported if a current provider does not join the network. GEHA allows continued treatment for a period at in-network levels to establish with a participating clinician.

GEHA customer service representatives can assist with locating providers by phone as an additional resource for those without Internet access.

Finding in-network options should not present a major obstacle in most areas thanks to GEHA’s extensive coverage. And out-of-network is also eligible for some services on an emergency basis if absolutely needed at the time.

What should I know about authorizations?

While GEHA waives pre-approval requirements for standard outpatient counseling, it may be needed for certain intensive services:

Inpatient mental health admissions require notification within 2 business days or as soon as medically possible during emergencies.

Partial hospitalization or intensive outpatient treatment programs require pre-certification to verify medical necessity.

Residential treatment centers, detoxification facilities and other specialized settings demand pre-authorization.

Any surgery, procedure, testing or imaging related to mental health diagnoses also necessitates GEHA approval upfront.

The process is mostly paperwork completed by your provider. It typically takes 1-2 business days for a routine decision. Of note:

GEHA approves over 90% of all authorization demands according to company reports.

Staff are available by phone, fax or electronically for providers to easily obtain clearance in real-time if needed urgently on weekends or holidays as well.

So while a few intensive services do require jumping through the hoop of pre-approval – GEHA makes it a streamlined process that rarely delays necessary treatment for members in crisis or recovery.

Any limitations on substance abuse coverage?

GEHA covers both mental health conditions and substance abuse issues as one integrated benefit. So rehab services receive equivalent levels of coverage, subject to similar deductibles, copays and network requirements detailed earlier.

A few specific points on addiction treatment:

  • Detoxification gets the same benefits as medical/surgical inpatient hospitalization.
  • Residential treatment centers and partial hospitalization addiction programs are fully covered.
  • Intensive outpatient rehab and outpatient services like counseling or groups use the standard mental health cost-sharing.
  • There is no annual or lifetime dollar cap that could halt recovery costs.

However, some limitation may apply if substance abuse stems from a non-covered condition like malpractice, crime or military service. Pre-existing condition exemptions also do not override such exclusions clearly attributable to a non- illness origin.

But for traditional chemical dependency issues eligible under medical plans – GEHA places no greater restriction on addiction coverage compared to other mental health treatments. Holistic recovery services receive full consideration.

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