Employee Assistance Program vs. Behavioral Health Coverage

The prevalence and treatment options for mental health issues were on the rise before the pandemic, but health concerns, lockdowns, and work-from-home arrangements caused by  COVID-19 have cast this issue further into the spotlight. According to the Journal of the American Medical Association (JAMA), the rate of depression in American adults has tripled since the onset of the coronavirus. Moreover, mental health issues have disproportionately affected lower-income demographics.

As if the world wasn’t demanding enough, the pandemic has introduced new stressors, such as  “Zoom fatigue,” associated with virtual video platforms. Workers who log in to meetings are expected to remain alert and engaged, be able to discern tone and body language over a computer screen, and all the while interruptions such as children, doorbells, and barking dogs may occur on multiple screens. It’s enough to make workers feel stressed out, burned out, and worry about how their professionalism is perceived.

Last June, a McKinsey survey of workers who had returned to the office found that one in three were experiencing negative mental health impacts. Half of those still working from home reported the same, with both groups naming concerns of safety and scheduling flexibility as major contributors.

Over the past decade, employers have introduced more benefits designed to help workers address mental health and substance abuse issues. These include coverage offered through company-sponsored health plans and Employee Assistance Programs (EAP). Now that behavioral health is at the forefront of workers’ minds, it’s a good time to help them understand the difference between these two programs.

Behavioral Health

Behavioral health programs are comprised of therapeutic resources to help workers develop healthy behaviors to nurture overall wellness. They may include counseling for mental health disorders, substance abuse, addiction, gambling, and support for healthy eating, movement, and meditation. The objective of workplace behavioral health programs is to help workers with personal problems so that they do not affect job performance. Specifically, treatments are designed to address behaviors that worsen symptoms and to develop habits that facilitate more positive outcomes.

Behavioral Health therapy is characterized by establishing a long-term relationship with a counselor to help with emotional health, substance abuse, depression, anxiety, and more.

These visits are generally covered under regular health insurance benefits. Note that, thanks to the changes set in place as a result of the COVID-19 pandemic, virtual visits also may be covered.

It is important for workers to seek out providers within their plan’s network for maximum coverage benefits. In-network providers generally charge a lower fee and will submit claims directly to the health insurance plan. However, mental and behavioral benefits may be subject to deductibles, copays, or co-insurance associated with the plan.

Employer Assistance Program

An Employer Assistance Program (EAP) is typically a separate benefit offered by an employer to help workers deal with short-term issues that may distract them from work. Many of these programs offer free or low-cost resources to address a wide variety of issues, such as:

• Short-term counseling – Up to a limited number of sessions (3 to 10) with a professional counselor to help address acute issues, such as coping with a recent loss, a marital problem, or other stressful event.
• Substance abuse referral services – Individual counseling and group support resources
• Financial counseling – resources to help workers develop a budget, manage and implement a debt payment plan, and learn about investing
• Legal services – free legal counseling for issues such as divorce and bankruptcy
• Adoption assistance – support for workers looking to adopt
• Child and eldercare services – primary resources and backup caregiving support
• ·Workplace trauma counseling – support for employees after incidents of workplace violence

Typically, an EAP will provide a limited number of behavioral health counseling sessions at no cost to workers. A sample EAP benefit may offer up to eight no-cost visits (per year), either in person, virtually, or a combination of both. Be aware that if the issue is not resolved in the number of counseling visits offered, workers may then transition to health plan behavioral health benefits. Therefore it’s a good idea to consider EAP benefits as a first option since it does not require fees or filing claims paperwork.

EAP counselors are often also included in the employer’s health plan network of providers, but it’s good idea to check beforehand. This will allow benefits to continue seamlessly from the EAP to the health plan using the same provider for continuity of care.

Virtual Care

In many scenarios, virtual health via phone, Facetime, Zoom, monitoring devices and remote diagnostics have replaced the traditional in-person examination throughout the pandemic. With high provider adoption rates and utilization, patients and medical staff learned the ropes quickly and greatly valued the option to provide/receive medical services from a safe distance. It is widely acknowledged that virtual medicine is one of the silver-lining, pandemic-induced changes that is here to stay.

This remote form of healthcare has been found to be particularly effective as a form of behavioral therapy. Studies have shown that various teletherapy models can effectively treat depression, substance use, and post-traumatic stress disorder (PTSD), among other conditions. In fact, throughout the pandemic, many substance abuse and addiction treatment centers have adopted outpatient services via phone and/or video telehealth. While some benefits of face-to-face interaction are lost, some critical advantages have emerged. For example, in-home sessions eliminate the need to find transportation or a babysitter.

Furthermore, some patients find they are able to share their feelings and experiences more openly from the comfort of their home rather than in a facility. The inherent distance of a phone or screen offers a heightened sense of security. In fact, this distance has made it easier for patients to admit when they’ve experienced a relapse, whereas in the past they were more likely to simply skip subsequent appointments.

A recent survey found that more than half of all consumers and an impressive 92 percent of providers say they intend to use virtual care more frequently in the future. Fortunately, behavioral health teletherapy is typically offered under both health plan and EAP benefits.

Big Upside, Low Downside

Offering behavioral health benefits via employer-sponsored healthcare plans and as part of an Employer Assistance Program is well worth the return on investment for employers. That’s  because research has shown time and again that when workers struggle with mental and emotional stress, they are more likely to take time off work or be less productive on the job.

A pre-pandemic projection estimated that workplace depression and anxiety collectively cost employers up to $1 trillion in productivity per year. By offering a combination of no-cost short-term counseling resources in combination with long-term behavioral therapy through a health plan, employers both encourage workers to seek help – and continue it as long as needed.

A key step to utilization is helping workers understand the differences in the two types of benefits, such as price, number of visits, and how to access each resource. In this environment of workers resigning to take another job or to simply take time off from working, mental health benefits can be effective at addressing core issues such as stress and burnout.

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