Supporting Staff Mental Wellbeing Without Putting Privacy at Risk
As an expat employer, should you self-insure outpatient mental health visits? More and more companies are asking this question.
Over the past few years, there’s been a sharp increase in the use of outpatient mental health benefits – a trend that is, in many ways, encouraging. It reflects a growing willingness to seek support and a wider cultural shift toward mental wellbeing.
But it also comes at a cost. For many companies, particularly those with international employees, this benefit is now a top driver of claims – and, by extension, of rising premiums at renewal time.
This is leading some employers – and some brokers – to explore alternatives, including the idea of self-insuring outpatient mental health benefits. But while this may sound reasonable at first glance, the approach comes with significant drawbacks that are often overlooked.
Why Companies Are Considering Self-Insuring
Most outpatient mental health benefits are capped – often between US$1,500 and US$5,000 per policy year — and cover a limited number of therapy or counseling sessions. Because of that cap, it may seem relatively low risk for companies to manage the reimbursement process themselves, especially if they believe they can negotiate preferential rates with selected local providers.
In theory, it could offer:
- Cost control and budget predictability
- Flexibility in how benefits are structured
- Tailored provider partnerships in each city or country
And indeed, some companies have successfully negotiated local packages or partnerships with trusted therapists — especially where insurers’ networks are thin.
But There’s a Major Catch: Confidentiality
Mental health isn’t just another outpatient benefit – and treating it as such can be risky. Unlike a dental claim or a physiotherapy bill, mental health treatment is deeply personal.
Self-insuring typically requires employees to submit reimbursement claims directly to HR or a company administrator, which raises immediate concerns about:
- Confidentiality and privacy
- Trust in the employer
- Stigma and reduced willingness to seek care
Even with robust internal processes, the perception alone that HR might have access to sensitive mental health information can be enough to discourage employees from using the benefit at all – defeating the purpose entirely.
Virtual Mental Health Care: A Smarter, Scalable Option – But With Limits
Rather than self-insuring, many insurers are now partnering with virtual mental health platforms to better manage costs while expanding access. These services offer secure, app-based therapy sessions, structured care plans, and flexible scheduling – ideal for expat employees in remote locations or in countries with limited mental health infrastructure.
Virtual care is especially well-suited for talk therapy, which makes up the majority of outpatient mental health use. However, it’s important to recognize that most virtual platforms do not include prescription medication support. For employees who require medications – such as for ADHD or depression – access to in-person psychiatric care must remain part of the benefit.
We strongly recommend structuring the plan to include both:
- Video-based therapy for broad, low-cost access
- In-person therapy or psychiatric care for cases requiring diagnosis and medication management
This hybrid model offers the best of both worlds: convenience and affordability, without sacrificing clinical depth or treatment continuity.
Our View: Don’t Self-Insure Mental Health
At One World Cover, we understand the need for cost containment – and we actively help our clients identify smarter ways to manage high-cost categories. But when it comes to outpatient mental health, we do not recommend self-insuring this benefit.
Why?
Because this isn’t just about financial exposure – it’s about access, trust, and employee wellbeing. Any solution that risks undermining those pillars could have far greater long-term costs than short-term savings.
Instead, we suggest:
- Leveraging insurer solutions that include virtual care
- Promoting existing International Employee Assistance Programs (IEAPs) more effectively
- Reviewing claims patterns to identify outliers or inefficiencies
- Considering moderate session caps if needed, without removing the benefit from the core plan
Outpatient mental health support has never been more important – or more widely used. Rather than scaling back or shifting risk back to the employer, we believe the right approach is to partner with insurers who are innovating in this space, and to communicate clearly with staff about how and when to access help.
If you’re reviewing your plan design and want to explore how to support mental health in a sustainable, cost-conscious way – let’s talk. We’ll help you balance compassion with control, and make sure your plan reflects the values of your organization.
To learn more please get in touch: [email protected] or click here to contact us.
