INCLUSION OF SOCIAL WORK SERVICES IN PRIVATE HEALTH PLANS

There has been a heated discussion amongst social workers this past week concerning the limited coverage of social worker services under some group plans insured by Great West Life.

According to Joan Mackenzie Davies, the Executive Director of the Ontario Association of Social Workers, there are a number of possible explanations for why employees with a group benefit plan under Great West Life, do not have coverage for social work services.

1. The employer/union does not see social work services as adding value/sufficient to the plan given other priorities;

2. The employer believes that adding social work services will drive up the number of claims and add costs to the plan;

3. The plan was inherited by GWL during one of the many insurance take-overs and never changed to add social work coverage.

“It is my experience that employers, not the insurance company, determine the content of group benefit plans.  The number of employers in the plan also increases the options employers consider.  Essentially, employers identify the features they want covered and then seek proposals from insurance companies to address these needs.  Insurance companies cost out a plan that they think is competitive and the employers agrees or disagrees depending upon what they can be negotiate and are willing to pay”.

Joan shared a sample letter (below) that OSAW encourages private practitioners to make available to clients/potential clients who do not have coverage. The letter essentially makes a case for plans to offer employees a choice regarding the provider they use.  The client can be sent to the union, employer or HR department depending upon the circumstances.  In settings where union contracts are under negotiation, Joan will call the union representative/head of the union and make a case for inclusion of social worker services in the group benefits plan if she is given the person’s name and contact information.   In cases where group benefits plans do not cover services that the plan holder believes should be covered (and are listed as available in the employee group plan booklet), the employer/union/HR department should be contacted to ask them to intervene, or at least, clarify why the service has not been covered.  Sometimes the problem simply is the result of a poorly informed claims person.

SAMPLE LETTER

RE: INCLUSION OF SOCIAL WORK SERVICES IN PRIVATE HEALTH PLANS

Letter to Employer/Human Resources Department or Union:

Dear

I am writing to request that the employee group benefits plan for our organization be expanded to include counselling services provided by social workers.  Coverage of social workers in our employee group benefits plan will provide greater choice for employees seeking counselling services.  Moreover, social work practice is regulated and services are both affordable and accessible across the province.

Given media reports of escalating workplace costs related to increased usage of disability and drug plans, lost productivity due to workplace stress and absenteeism, as well as the expense of finding and training replacement staff, adding social work counselling services to our group benefits plan not only assists in maintaining a healthy and productive work force, but it also makes economic sense for the organization.

It is worth noting that social workers are one the largest groups of practicing counsellors and psychotherapists in North America and are included in the recently passed Psychotherapy Act, 2007.

I look forward to hearing from you regarding the addition of social work services to our group benefits plan.  For more information about the social work profession, you can visit www.oasw.org or www.ocswssw.org.

Sincerely,

Joan MacKenzie Davies, M.S.W., Res.Dip.S.W., RSW
Executive Director
Ontario Association of Social Workers
(416) 923-4848 ex. 232
fax: (416) 923-5279
jmd@oasw.org