A Short Course of EAP Benefit Design

Essential to your success as an EAP practitioner is a clear understanding of general practices in EAP benefit administration. Awareness of the differences in EAP plans will help you approach client assessment and referral in a clinically sound, ethically grounded way.

EAP plans vary significantly because they are specific to each employer group contracting with MHN to provide services to its employees. Plans may also vary within an employer group, according to employee job title, length of service, union representation or other factors. In some cases, employees and their eligible dependents have different benefit levels.

EAP plans are usually defined as “per incident,” “per problem type,” or “per benefit year.” Your practitioner authorization letter informs you of the number of sessions authorized for a specific episode of treatment but does not contain more general information about each client's overall benefit design. It is recommended that discussion of available benefits (including community resources and managed care) be included in your assessment so that you and the client can make appropriate decisions regarding treatment. If more information about a specific plan is needed, contact MHN.

Under “per incident” plans, enrollees may access their EAP more than once if discrete presenting issues are identified within a given contract year. When additional “per incident' authorizations are requested, MHN clinicians provide oversight during the intake process to determine if referral is appropriate.

For example, a member who has up to three sessions “per incident” each calendar year calls MHN in January to access her benefits for marital issues. A referral is made and an authorization for this “incident” created. Because the enrollee will receive a thorough assessment and brief counseling or treatment referral for marital (and associated) issues, an additional authorization for this presenting issue will be unnecessary under most circumstances. However, when in August the same member again calls MHN for referral, citing job-related stress, she is transferred to an MHN staff clinician, who briefly assesses the caller and determines that the presenting issue is unrelated to her initial access; another EAP referral is authorized.

“Per problem type” plans are similar in that clients may receive additional authorizations for discrete presenting issues within a given contract year, but the problem types are specified by the EAP benefit plan. Examples of clinical problem types for which referrals can be made are:

• Substance abuse
• Marital and family issues
• Emotional, personal and stress concerns

Many EAP plans allow a finite number of sessions per eligible member each contract year, regardless of presenting issue. These sessions may be used for one or more referrals, as requested by the member and as clinically appropriate.

Some members-usually in high stress/high risk professions such as fire fighting or police work-have specially tailored EAP plans that enable them to access benefits whenever they are adversely affected by issues arising from job related experiences. These plans are not intended as ongoing managed care coverage for serious psychological diagnoses such as major depression, anxiety disorders or chronic substance abuse. If you are unsure as to whether or not EAP services are appropriate for any member or need assistance with other clinical concerns, an MHN Clinical Case Specialist (CCS) can help you assess members' needs and determine appropriate treatment recommendations.

We always welcome calls from our valued EAP practitioners. MHN clinical and administrative service teams are available 24/7 to provide information and expertise in managing your EAP referrals.