Exhibit 4.9: Percentage of Covered Workers with Various Annual Outpatient and Inpatient Mental Health Maximums, 2004
Although most covered workers had inpatient and outpatient mental health benefits in 2004 (98%, see
Exhibit 4.1), they typically faced limits on the number of outpatient mental health visits (81%) and the number of inpatient mental health days (79%) covered by their health plans. For outpatient visits, the limit was most typically 30 visits or fewer (63%), with 32% of covered workers having maximums of 20 or fewer visits. The limit on inpatient days was most typically 21-30 days (45%), with 14% of covered workers having maximums of 20 or fewer days.
Percentage of Covered Workers With Various Annual Outpatient Mental Health Visit Maximums, by Plan Type, 2004*
| Conventional | HMO | PPO | POS | All Plans |
20 Visits or Fewer | 25% | 48% | 26% | 32% | 32% |
21 to 30 Visits | 26 | 26 | 34 | 28 | 31 |
31 to 50 Visits | 5 | 6 | 11 | 8 | 9 |
More than 50 Visits | 9 | 5 | 9 | 14 | 9 |
Unlimited Visits | 35 | 15 | 19 | 17 | 19 |
Percentage of Covered Workers With Various Annual Inpatient Mental Health Day Maximums, by Plan Type, 2004*
| Conventional | HMO | PPO | POS | All Plans |
10 Days or Fewer | 5% | 4% | 7% | 5% | 6% |
11 to 20 Days | 8 | 9 | 8 | 6 | 8 |
21 to 30 Days | 44 | 47 | 45 | 46 | 45 |
31 or More Days | 17 | 21 | 18 | 26 | 21 |
Unlimited | 27 | 18 | 22 | 17 | 21 |