Mental health has been receiving a lot of attention recently. The pandemic has put additional strain on people, and according to a poll from USA Today and Suffolk University, nearly 90% of respondents think there is a mental health crisis in the United States. But despite all the talk about mental health, are mental health benefits keeping pace with mental health needs? Here’s a look at what’s happening now in mental health benefits.

Health Insurance and Wellness Programs

According to, the Affordable Care Act requires most individual and small group health insurance plans to cover mental health and substance use disorder services. Furthermore, coverage for mental health and substance use disorders cannot be more restrictive than coverage for medical and surgical services. Medicaid and Medicare programs also cover mental health services.

Beyond the benefits provided in group health plans, many employers have been adding additional mental health benefits, such as counseling and subscriptions to mental health apps. According to KFF’s 2021 Employer Health Benefits Survey, 31% of employers expanded the ways enrollees could get mental health and substance abuse services, for example, by offering telemedicine, and 16% of employers added employee assistance programs or other new resources. Additionally, when it comes to coverage for mental health and substance abuse services, 3% of employers increased coverage for out-of-network care, 4% waived cost sharing and 6% expanded the number of providers in their network.

COBRA Insurance

Some mental health services are covered under COBRA. The DOL says that group health plans are subject to COBRA. Therefore, mental health services covered under a group health plan should also be covered by COBRA. However, wellness programs that do not qualify as a group health plan may not be subject to COBRA. This distinction can be tricky. According to LexisNexis, wellness programs that provide medical care count as group health plans, but wellness programs that only promote good health likely to do not provide medical care or count as group health plans.

Employees at smaller companies may also be out of luck. Federal COBRA rules only apply to employers with at least 20 employees. This means that employees at smaller companies may not have any COBRA benefits, including mental health benefits. However, many states have their own healthcare continuation laws that apply to smaller companies, so these employees may have coverage under state law.

FSAs and HSAs

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) allow individuals to save money for out-of-pocket healthcare costs without paying taxes on those funds.

According to, FSAs and HSAs can be used to pay for certain medical expenses. However, not all expenses are allowed. A list of generally permitted expenses from the IRS includes therapy, but only if it is received as medical treatment. Based on this definition, it seems possible that therapy or counseling could be considered ineligible if it’s not connected to a medical diagnosis or recommended by a primary care physician. For people who need counseling to help with relationship issues, work problems or general anxiety or stress, this could be a problem.

Are You Keeping Pace with Mental Health Benefits Administration?

As employers tackle mental health, employee benefits administration is getting more complicated. Travisoft can simplify benefits administration by providing COBRA administration, Open Enrollment, Retiree & Direct Billing and Print Fulfillment services. Request your Travisoft demo.