By Luzia Hung, Chief of Pension & Group Business, AXA Hong Kong
Achieving mental health is about striking a balance in the social, physical, spiritual, economic and mental aspects of our lives. With the hustle and bustle of living in the congested city of Hong Kong, you may hardly notice your anxiety turning to distress; until one day, you feel overwhelmed. This kind of mental discomfort is prevalent in Hong Kong, especially in the workplace.
It is worthwhile setting aside time to review the current scope of coverage under your company’s group medical scheme. As part of the review, HR teams should ascertain whether current coverage is comprehensive enough to take care of employees suffering from mental illness.
Mental disorders cause a significant healthcare burden in Hong Kong. Mental disorders took up 23.2% of hospital bed day utilisation in 2000 (Research Office of the Health Welfare and Food Bureau, 2002). In 2003, 15,346 persons were registered with the Hospital Authority as having some forms of mental illness, of whom 12,979, 84.6%, had psychotic symptoms.*
Most importantly, an increasing trend is observed that more and more working people are suffering from mental illness or mood disorders. Relevant treatments to these problems are usually not one-off solutions, but require long-term recovery periods with relatively high medication expenses. Moreover, expenses for treating such diseases are normally not covered by most of the group medical insurance schemes offered in the market. Some insurance companies exclude mental illness as it does not constitute any visible impairment, and it is hard to measure the status of recovery.
Mental illness in the workplace
About 10% of the Hong Kong population suffer from mental illness, with the majority of cases being mood disorders. This concurs with the WHO Health Report 2001, which estimated that mental health problems constituted 10% of the global disease burden. The most common mental illnesses were depression, anxiety, substance abuse and psychotic disorders.Types of mental illness
Mental illness can be categorised into several key types, and the most common are as follows:
- Anxiety disorders: diagnosed if a person’s response is not appropriate for the situation, if a person cannot control their response, or if the anxiety interferes with normal functioning. Anxiety disorders include generalised anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder and specific phobias.Mood disorders: also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. Among the most common mood disorders are depression, mania and bipolar disorder.
- Psychotic disorders: involve distorted awareness and thinking. Two of the most common symptoms are hallucinations—an experience of images or sounds that are not real, such as hearing voices; and delusions—false beliefs that the sufferer accepts as true, despite evidence to the contrary. Schizophrenia is a typical example of a psychotic disorder.
- Eating disorders: involve extreme emotions, attitudes, and behaviours involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders.
- Impulse control and addiction disorders: sufferers are unable to resist urges or impulses, and perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are among the most common addictions.
- Personality disorders: sufferers have extreme and inflexible personality traits that are distressing to the person and/or cause problems in relationships at work, school, or in social settings.
Insurance coverage for mental illness
Increasing work tension and pressure is a major reason for mental ailments. More employees have raised concerns over having no coverage for mental illness under their medical insurance scheme. Employers have thus become increasingly aware of the need to review their policies in this regard.
Doctors in Hong Kong at the same time also advocate that there should be more choices of insurance plans that cover mental illness and employers should subscribe to such plans for their employees. The Hong Kong Medical Association and the Chairman of the Association’s Committee on Rehabilitation have both also urged the government to promote this kind of insurance coverage in the workplace.
In Hong Kong, mental illnesses are generally not covered under group medical insurance policies. However, certain insurance companies, including AXA, do cover staff treated by psychiatrists instead of psychologists. This is because psychiatrists are registered medical practitioners and are qualified to prescribe medication whereas psychologists are not.
Engaging staff with medical coverage
Employers can provide group medical insurance coverage to their employees as an employee benefit to enhance staff engagement and retention. They may also consider including coverage of mental illnesses under such policies, in light of the growing awareness of such conditions, and their association with hectic working environments.
In view of the fact that most insurance policies carry certain exclusion items, mental illness being one of them, employers should regularly review their policy terms. They should pay attention to the exclusions section, to determine whether the current coverage meets their requirements.Typical major exclusions in medical insurance policies include: congenital anomalies, pre-existing conditions, pregnancy, general check-ups and mental illness. In addition to the exclusion terms, employers should also make comparison of different insurance schemes and providers with regard to the following aspects outlined below.
Policy terms and conditions, such as definition of pre-existing conditions & benefit reimbursement
Clause for cessation at work i.e. membership termination after the absence from work for six monthsGeographical limitationsCustomer serviceCompany background, including financial strengths and industry credentials
Most insurance companies put mental illness under the exclusion section for the sake of keeping the overall premium within an acceptable and affordable level. If an employer considers it necessary to extend the policy’s coverage to include some excluded conditions, they can ask the insurance provider to include such exclusions at a higher premium.
Pregnancy and general check-ups are among the exclusions that employers are most willing to pay additional premiums for in order to have them covered.
Once an employer determines the scope of coverage, it is important to ensure that employees have a clear understanding on the inclusion and exclusion items to avoid disputes arising in future. Employers should disseminate booklets detailing key benefits and coverage of insurance schemes. It is also recommended to further enhance communication with staff by organising employee briefing sessions to explain scheme features and address enquiries staff may have about the scheme. Offsite wellness classes on stress management can also assist HR in building stronger and more highly engaged teams.
Paul Arkwright
Publisher
