Mandatory Rehabilitation (Case study: Mental Health)
Mandatory Rehabilitation (Case study: Mental Health)
To encourage disabled
persons to participate in rehabilitation programs, some policies include a
mandatory rehabilitation provision. This provision states that if an individual
refuses to cooperate or participate in a rehabilitation program, benefits will
be terminated. A typical example of a rehabilitation clause may be as follows;
"In the case of medical treatment a participant must receive appropriate medical
treatment beginning with the onset of the condition involved and continuing
throughout both the Elimination Period and any subsequent payment period. This
will normally mean treatment that involves more than examination or testing.
It
must be reasonable and customary, performed or prescribed by a Physician or,
whenever considered necessary by the Company, a medical specialist. Treatment
must be carried out as frequently as the condition requires. Partcipant's
responsibilities while disable during any period of disability, the Participant
must make reasonable efforts to: Recover from the disability, including
participating in any reasonable treatment or return to work assistance program."
In some jurisdictions for example in the USA a great percentage of drug rehab
attendees used private insurance to pay for treatment. According to the The
Mental Health Parity and Addiction Equity Act of 2008; "stipulates that
insurance companies cannot discriminate against or deny coverage to individuals
with substance use disorders. In addition", the Affordable Care Act of 2010:
"classified mental health and addiction services as essential health benefits"
This means insurance companies have to treat mental health and substance abuse
treatment similar to regular health treatment. Every insurance company has a
different coverage plan that can be tailored to the individual’s needs.
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