Sample Mental Health Benefits

Sample_Documents

DISCLAIMER: This is a sample template provided for informational purposes only. It does not constitute legal, tax, or financial advice. Organizations should consult their own legal and tax advisors and tailor this document to reflect their specific business needs, geographies, and applicable laws.

Document Header

Field	Value
Document Title	Mental Health Benefits
Document Type	Benefits & Wellness
Category	Mental Health Benefits
Company	<Company Name>
Version	<Version Number>
Effective Date	<Date>
Last Review Date	<Date>
Next Scheduled Review	<Date> (typically 12 months after effective date)
Document Owner	<Owner Title/Department> (for example, Total Rewards)
Approver(s)	<Approver Name/Title>
Geographic Scope	<Country/Region(s)>
Confidentiality	Internal Use Only

Purpose and Objectives

• Define a clear, equitable, and compliant mental health benefits program aligned with <Company Name> values and wellbeing strategy
• Improve access to high-quality mental health care within reasonable timeframes, including virtual care
• Reduce financial barriers through predictable cost sharing and employer-paid programs
• Support early intervention, recovery, and sustained mental health for employees and eligible dependents
• Integrate with medical, pharmacy, disability, and leave programs to deliver a seamless employee experience
• Provide governance, vendor management, and measurement practices to ensure continuous improvement

Scope and Applicability

In Scope

• Employer-sponsored mental and behavioral health benefits provided through insured or self-funded medical plans
• Employee Assistance Program and crisis support
• Substance Use Disorder services, including inpatient, outpatient, intensive outpatient, and partial hospitalization programs
• Teletherapy and telepsychiatry services via <Vendor Name> or medical plan network
• Digital cognitive behavioral therapy tools and coaching programs
• Work accommodations related to mental health under <Country> law
• Global guidance and country-level adaptations for <Country/Region(s)>

Out of Scope

• Clinical practice guidelines and standards of care, which are determined by providers and health plans
• Workers’ compensation programs, unless specifically integrated by policy
• Independent legal advice for employees
• Emergency response or security protocols outside of crisis triage referral

Applicability

• All regular employees of <Company Name> scheduled to work at least <Hours per Week> hours
• Eligible dependents as defined in the medical plan (for example, spouse/domestic partner and children up to age <Age>)
• Contingent workers and interns only where mandated by local law or specific contract terms
• Country-specific eligibility rules will be documented in local appendices

Guiding Principles

• Parity and equity: Mental health benefits will meet or exceed parity with medical and surgical benefits and be free from discriminatory limits
• Access first: Multiple entry points including EAP, telehealth, in-person care, and crisis support
• Quality and outcomes: Preference for evidence-based modalities and credentialed providers
• Privacy: Strong safeguards for confidential employee information
• Affordability: Predictable costs, with company-paid options for early support
• Inclusive care: Coverage for diverse needs, including culturally competent and language-accessible services

Program Overview

• <Company Name> offers a layered model of support:
  • Self-guided: Digital tools, education, and preventive resources
  • Early support: EAP counseling sessions and coaching
  • Clinical care: Therapy, psychiatry, and structured programs covered under the medical plan
  • Crisis: 24/7 access to trained clinicians and referrals
• The program integrates with leave, disability, and accommodation processes to support recovery and return to work
• Primary access channels include <Vendor Name> (EAP), <Medical Plan Name>, and <Telehealth Vendor Name>

Eligibility and Waiting Period

• Benefits commence on <Date> or after a waiting period of <Number of Days> days from hire, unless mandated earlier by <Country/State> law
• Dependents become eligible when the employee is eligible and enrolled in the medical plan, subject to plan terms
• COBRA or continuation of coverage is available as required by law

Plan Design and Coverage

Summary of Core Benefits and Cost Sharing

Benefit Category	What is Covered	Member Cost Share	Annual Limits	Preauthorization
EAP Counseling	Short-term counseling sessions via <Vendor Name>	$0 per session	Up to <Number> sessions per issue per year (example: 6)	Not required
Outpatient Therapy	Licensed therapy (individual, family, couples) in-network	Copay <Amount> or <Percentage> coinsurance (example: $25 or 20%)	No annual limit, medical necessity applies	Not required for routine care
Teletherapy	Video or phone sessions via <Telehealth Vendor Name>	Copay <Amount> or $0 if using <Vendor Name> promotional rate	Same as outpatient therapy	Not required
Psychiatric Services	Evaluation and medication management	<Percentage> coinsurance after deductible (example: 20%)	No annual limit, medical necessity applies	May be required for complex cases
Intensive Outpatient (IOP)	Structured day programs	<Percentage> coinsurance after deductible	Up to <Number> days per year, per medical necessity	Required
Partial Hospitalization (PHP)	Hospital-based daytime programs	<Percentage> coinsurance after deductible	Up to <Number> days per year, per medical necessity	Required
Inpatient Mental Health	Acute stabilization and treatment	<Percentage> coinsurance after deductible	Up to <Number> days per admission as medically necessary	Required
Substance Use Disorder	Detox, inpatient, IOP, outpatient	Parity with mental health benefits	Parity with mental health benefits	Required for inpatient
Medications	Mental health prescriptions under pharmacy plan	Copay tiers <Amount>/<Amount>/<Amount>	Per pharmacy policy	As per formulary rules
Digital CBT and Coaching	App-based programs via <Vendor Name>	$0	Unlimited access	Not required
Crisis Support	24/7 hotline and clinician triage	$0	Unlimited	Not required

Coverage Details and Examples

• EAP provides short-term, solution-focused counseling for issues such as stress, anxiety, grief, relationship concerns, parenting, financial stress, and referrals for specialty care. Sessions do not require medical diagnosis and are confidential.
• Outpatient therapy is covered for evidence-based modalities such as CBT, DBT, EMDR, ACT, and family systems therapy when provided by licensed clinicians. Sessions typically last 45 to 60 minutes.
• Teletherapy and telepsychiatry offer convenience and expanded networks, especially in areas with provider shortages.
• Psychiatric services include initial diagnostic assessments, ongoing medication management, and coordination with therapy.
• Substance Use Disorder care is covered at parity with mental health under plan terms, including MAT programs when clinically appropriate.
• Crisis care includes immediate telephonic support, safety planning, and referrals. If a member is in imminent danger, they should contact local emergency services.

Out-of-Network and Balance Billing Considerations

• Out-of-network services are covered at <Percentage> coinsurance after an out-of-network deductible of <Amount> where permitted by law
• Members may be responsible for amounts billed above the plan’s allowed amount when using out-of-network providers, subject to applicable balance billing protections in <Country/State>

Prior Authorization and Medical Necessity

• Certain services require prior authorization, including inpatient, PHP, and IOP levels of care
• Medical necessity is determined by the plan’s clinical criteria and applied consistently with parity requirements
• Denied requests may be appealed through a formal process outlined by <Medical Plan Name>

Limitations and Exclusions

• Non-licensed providers or services that are experimental, investigational, or not evidence-based may be excluded
• Court-ordered services not deemed medically necessary by the plan may be excluded
• Missed appointments and late cancellation fees are not covered
• Academic or life coaching not provided by qualified clinicians may be excluded unless offered through the EAP or digital program

Illustrative Cost Scenario

• An employee uses teletherapy in-network for 10 sessions with a $25 copay per session. Total out-of-pocket cost is $250. If using EAP first for 6 sessions at $0, the remaining 4 sessions through the medical plan would cost $100.

Access and Enrollment

Enrollment and Eligibility Verification

• Employees enroll in mental health benefits when electing medical coverage during new hire enrollment or open enrollment
• EAP and digital tools are available to all eligible employees and household members regardless of medical plan enrollment, unless otherwise stated

Finding a Provider

• Use <Medical Plan Name> online directory to search for in-network therapists or psychiatrists
• Contact <Telehealth Vendor Name> for same-week virtual appointments
• Call <Vendor Name> EAP for concierge navigation to providers with confirmed availability

Getting Care and Referrals

• No referral is required for outpatient therapy in-network
• For inpatient, PHP, or IOP, request authorization through <Medical Plan Name> before admission when possible
• For prescription needs, see a psychiatrist or primary care provider who can prescribe under the pharmacy plan

Coverage While Traveling or on Assignment

• Teletherapy is available across <Country/Region(s)> where permitted by licensure
• International travelers may access EAP by phone and digital tools; clinical coverage follows the expatriate or local medical plan

Employee Assistance Program (EAP)

• Vendor: <Vendor Name>
• Availability: 24/7/365 by phone, chat, and video
• Cost: $0 to employees and household members for covered services
• Services:
  • Short-term counseling up to <Number> sessions per issue per year
  • Legal and financial consultations for personal matters
  • Work-life support such as childcare, eldercare, and tutoring referrals
  • Critical incident response and manager consultation
  • Digital wellbeing content and self-guided programs
• Service standards:
  • Answer time under <Number> seconds
  • Appointment offered within <Number> business days
  • Multilingual support in <Number> languages

Substance Use Disorder Support

• Coverage aligns with mental health parity and includes detox, MAT, and relapse prevention
• No lifetime maximums; utilization review applies to ensure appropriate level of care
• EAP offers motivational interviewing and referral to specialty programs
• Confidential peer support groups may be available through <Vendor Name>

Integration with Leave and Accommodations

• Employees may be eligible for protected leave under <Country/State> law for serious mental health conditions
• Short-Term Disability through <Carrier Name> may replace a portion of income during medically necessary leave
• Job accommodations may include schedule flexibility, remote work, reduced distractions, or modified duties
• Process:
  • Employee or manager contacts <Leave Administrator Name>
  • Medical certification submitted within <Number> days
  • Interactive process engages employee, manager, and HR to identify reasonable accommodations

Privacy and Confidentiality

• EAP and clinical providers do not share identifiable information with <Company Name> without employee consent, except where required by law to prevent harm or respond to court orders
• Group-level, de-identified reporting may be used to assess utilization and program effectiveness
• All vendors must comply with <Country> data protection laws and contractual data security standards

Global Considerations

• Country-level variations will reflect local social insurance, insurer practices, and cultural norms
• For countries with universal coverage, the company may supplement access with employer-paid private sessions, telehealth, or navigation support
• Local employee representatives or works councils will be consulted where required
• Translations and culturally relevant providers will be prioritized

Roles and Responsibilities

• Total Rewards owns strategy, plan design, vendor selection, budgeting, and governance
• Benefits Operations manages daily administration, escalations, and issue resolution
• Leave and Disability Team coordinates job-protected leave, STD/LTD, and accommodations
• HR Business Partners support managers and teams, and refer to appropriate resources
• Managers foster a supportive environment, use the EAP for consultations, and avoid diagnosing or counseling employees
• Employees select providers, attend appointments, follow treatment plans, and safeguard their own privacy preferences
• Vendors ensure network adequacy, quality assurance, service level performance, data security, and reporting

Vendor Management and Quality

Selection Criteria

• Clinical quality framework, credentialing, and supervision
• Network adequacy, including availability for underrepresented groups and languages
• Time-to-appointment and member satisfaction metrics
• Data security, privacy, and compliance posture
• Cost transparency and parity adherence
• Implementation support and change management capabilities

Service Level Agreements (SLAs)

• EAP answer time under <Number> seconds
• First available appointment within <Number> business days for therapy and <Number> days for psychiatry
• Clinical quality audits with corrective action plans within <Number> days
• Reporting cadence monthly and quarterly with agreed metrics

Reporting and Metrics

• Utilization rates for EAP, therapy, psychiatry, and digital tools
• Average wait times by modality and region
• Clinical outcomes such as PHQ-9 and GAD-7 improvement where available and de-identified
• Return-to-work rates and disability durations for mental health claims
• Member experience scores and complaint rates
• Cost per member per month and trend

Budgeting and Funding

• EAP typically funded on a per-employee-per-month basis of <Amount> to <Amount>
• Medical plan coverage funded via insured premiums or self-funded claims with ASO fees of <Amount> PMPM
• Digital tools may be priced per registration or enterprise license of <Amount> per year
• Budget assumptions should include expected utilization, network discounts, and promotional incentives
• ROI assessment considers reduced absenteeism, improved productivity, lower disability durations, and avoided higher-cost care

Compliance and Risk Management

• Comply with mental health parity regulations in <Country/Region>
• Ensure non-quantitative treatment limits are not more restrictive than those for medical/surgical benefits
• Provide required notices and SBC updates during open enrollment and midyear changes as applicable
• Maintain business associate/data processing agreements with vendors
• Conduct annual privacy and security reviews and incident response drills
• Review plan documents and SPDs to ensure accurate, current descriptions of benefits

Implementation Guidelines

Project Timeline

Phase	Target Dates	Key Activities
Strategy and Design	<Date Range>	Define objectives, benchmark, design benefits, model costs
Vendor Selection	<Date Range>	RFP, demos, due diligence, references, contracts
Build and Configure	<Date Range>	Eligibility files, plan setup, EAP configuration, telehealth integration
Testing	<Date Range>	File testing, directory audits, claims testing, SLA validation
Training and Launch	<Date Range>	HR and manager training, communications, go-live
Stabilization	<Date Range>	Monitor issues, hypercare, initial reporting

Implementation Checklist

1. Confirm plan design and parity review completed by <Legal Counsel Name>
2. Finalize vendor contracts with defined SLAs and data security terms
3. Build eligibility and billing files with <Vendor Name> and complete end-to-end testing
4. Load provider directories and validate specialty tags and language attributes
5. Configure telehealth benefits and confirm copays across platforms
6. Draft and approve Summary Plan Description and SBC updates
7. Train HR, managers, and EAP account managers on referral and escalation pathways
8. Launch communications and update benefits portal with access instructions
9. Establish monthly and quarterly reporting cadence and review metrics

Review and Approval Process

• Document owner drafts updates following annual review or regulatory changes
• Stakeholders include Total Rewards, Legal, Compliance, HR Operations, and <Regional HR>
• Approvals:
  • Technical design sign-off by <Title>
  • Legal sign-off by <Counsel Name>
  • Final approval by <Executive Sponsor Title>
• Versioning:
  • Version numbers increment for minor updates (for example, 1.1) and major revisions (2.0) upon significant design changes
• Effective dates:
  • Changes generally effective <Date> unless mandated earlier by law or collective agreements

Version History

Version	Effective Date	Summary of Changes	Author	Approver
<Version Number>	<Date>	Initial release	<Name>	<Name>
<Version Number>	<Date>	Updated telehealth copay and EAP sessions	<Name>	<Name>

Exceptions and Escalations

• Case-by-case exceptions may be considered for urgent access, geographic limitations, or unique clinical needs
• Requests process:
  • Employee or HR submits an exception request to <Benefits Operations Email>
  • Documentation of clinical need or access barriers included
  • Decision within <Number> business days by Total Rewards with Legal review when needed
• Appeals follow the health plan appeal process for coverage determinations

Manager Guidance

• Managers should:
  • Encourage use of resources without asking for diagnosis or details
  • Refer to EAP for consultation when concerned about an employee
  • Partner with HR on accommodations and performance expectations
  • Maintain confidentiality and avoid storing medical information in team files
• Managers should not:
  • Provide medical advice or attempt to counsel employees
  • Request medical records directly from employees
  • Retaliate or discriminate based on mental health status

Data Governance and Reporting

• Data sources include de-identified EAP utilization, medical and pharmacy claims, and vendor-reported metrics
• Reporting cadence:
  • Monthly dashboard for access and SLAs
  • Quarterly review for outcomes and cost trends
  • Annual strategy review with recommendations
• Access controls:
  • Limit identifiable data to those with a need to know (for example, leave team)
  • Store reports in <Secure System Name> with role-based permissions

Risk Register

Risk	Likelihood	Impact	Mitigation
Network provider shortages	Medium	High	Add telehealth, concierge navigation, and out-of-network options with caps
Parity non-compliance	Low	High	Annual legal review and comparative analysis of NQTLs
Data breach at vendor	Low	High	Contractual security controls, audits, incident response plans
Low awareness and utilization	Medium	Medium	Targeted communications, manager training, and campaign cycles
Stigma and cultural barriers	Medium	Medium	Culturally relevant messaging and providers, translation services

Audit and Continuous Improvement

• Annual parity compliance assessment with documented results and remediation plans
• Provider access audits including secret-shopper calls
• Clinical quality reviews of vendors with corrective action plans
• Employee feedback loops via pulse surveys and EAP satisfaction data
• Iterative plan design updates to improve access and outcomes

Glossary

• ACT: Acceptance and Commitment Therapy
• CBT: Cognitive Behavioral Therapy
• DBT: Dialectical Behavior Therapy
• EAP: Employee Assistance Program
• IOP: Intensive Outpatient Program
• LTD: Long-Term Disability
• NQTL: Non-Quantitative Treatment Limitation
• PHP: Partial Hospitalization Program
• PMPM: Per Member Per Month
• PHQ-9/GAD-7: Standardized screening tools for depression and anxiety
• STD: Short-Term Disability
• Telepsychiatry/Teletherapy: Mental health services delivered via secure video or phone
• Utilization Review: Clinical review to determine medical necessity
• Parity: Requirement that mental health benefits are no more restrictive than medical/surgical benefits

Communication Section

Mental Health Support at <Company Name>: What You Need To Know

At <Company Name>, your mental health matters as much as your physical health. When life gets stressful, you have multiple ways to get confidential support, on your terms. Most services are easy to access, with short wait times and low or no cost to you. Whether you prefer self-guided tools, short-term counseling, or ongoing care with a therapist or psychiatrist, help is available.

Here is how the support system works:

• Start with the Employee Assistance Program by calling <EAP Phone Number> or visiting <EAP Website>. You and your household members can speak with a counselor at no cost. You will get up to <Number> sessions per issue each year. If you need longer-term care, the counselor will help you find a provider covered by your health plan.
• Prefer virtual care? Use <Telehealth Vendor Name> for video therapy or psychiatry. Appointments are often available within <Number> days. Costs are the same or lower than in-person care, and many visits are covered with a low copay.
• If you already have a therapist or want in-person care, search the <Medical Plan Name> provider directory for in-network mental health providers. No referral is needed for routine outpatient therapy.
• If you or someone close to you is in crisis, call <Country> emergency services or the 24/7 crisis line at <Crisis Number>. You will speak with a trained clinician who can help with safety planning and next steps.

What to expect when you reach out:

• For EAP appointments, you will be offered a time within <Number> business days. Many counselors offer evening and weekend hours.
• For therapy or psychiatry through the health plan, you can choose in-person or virtual visits. If you have trouble finding an appointment, call the number on your insurance card and ask for concierge help.
• Your privacy is protected. <Company Name> will not know who used the EAP or what was discussed. Information is only shared if you request it or if required by law to keep someone safe.

Costs in a nutshell:

• EAP counseling sessions: $0
• In-network therapy: Copay <Amount> or coinsurance <Percentage> after deductible, depending on your plan
• Teletherapy: Same as in-network therapy, and sometimes lower with <Telehealth Vendor Name>
• Psychiatric care: Coinsurance <Percentage> after deductible
• Digital tools and coaching via <Vendor Name>: $0

How to get started today:

1. Save these contacts: EAP <EAP Phone Number> and <EAP Website>, Health Plan <Member Services Number>, Telehealth <Telehealth Website>
2. Take a confidential self-check using PHQ-9 or GAD-7 through <Vendor Name> to understand your symptoms
3. Schedule a first session with EAP or a therapist and put it on your calendar
4. Talk to your manager or HR if you need flexibility for appointments or would like to explore accommodations

Support for managers:

• If you are concerned about a team member, call the EAP for a management consultation. You can discuss how to approach difficult conversations, set expectations, and connect the employee with resources.
• Keep conversations focused on performance and support, not diagnosis. Offer flexibility when possible and partner with HR on accommodations.
• After a difficult team event, such as a loss or critical incident, you can request on-site or virtual support sessions through the EAP.

Frequently asked questions:

• Is the EAP confidential? Yes. The EAP does not share names or session details with <Company Name> without your written permission, except to keep someone safe or when required by law.
• Do I need a referral? No referral is required for routine therapy. Some intensive services may require prior authorization by the health plan.
• Can my family use the EAP? Yes. Household members can use EAP services at no cost.
• What if I cannot find a provider? Call the number on your health plan card or the EAP. They can help you locate a provider with availability or offer virtual options.
• What if I need time off for treatment? You may qualify for protected leave or disability benefits. Contact <Leave Administrator Name> to learn more.
• What if I am outside <Country>? Many services are accessible by phone or virtually. Coverage may vary by location, so check your local benefits guide or contact HR.

In a crisis:

• If there is an immediate danger, call local emergency services right away
• For urgent emotional support, call <Crisis Number> available 24/7
• After you are safe, contact the EAP to arrange follow-up support

Remember, reaching out early can make a big difference. You do not need to wait until things feel overwhelming. Whether you want to build resilience, navigate a tough time, or support someone you care about, help is here.

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Document Information:

• Document Type: Mental Health Benefits
• Category: Benefits & Wellness
• Generated: August 25, 2025
• Status: Sample Template
• Next Review: <Insert Review Date>

Usage Instructions:

1. Replace all text in angle brackets < > with your company-specific information
2. Review all sections for applicability to your organization
3. Customize content to reflect your company's policies and local regulations
4. Have legal and HR leadership review before implementation
5. Update document header with your company's version control information
6. At bottom of the document you find a short example on how the content could be communicated to end-users, for instance employees.

This sample document is provided for reference only and should be customized to meet your organization's specific needs and local legal requirements.