Getting the most out of your EAP visits

What is an EAP?

Employee assistance programs (EAPs) are a wellness benefit that is separate from your primary health insurance plan. EAPs offer short-term engagement and support for employees around mental health — from anxiety and depression to everyday stressors like caregiving and work-life balance. 

Alma is now in-network with Optum’s Live & Work Well Employee Assistance Program, and you can search the Alma directory to find providers in your area who accept Optum EAP benefits. We are not currently contracted with any other EAP benefit outside of Optum.

Why are EAPs important?

EAPs give additional mental health coverage outside of the framework of a formal insurance plan, at no cost to you as a client. You can use these benefits for short-term clinical interventions (such as relationship counseling or maintaining work-life balance) without paying a copay, coinsurance, or deductible.

If you do not currently have access to health insurance, or if you are paying down a high deductible on your health plan before you can access your full health plan benefits, EAPs can provide an alternative means for receiving care quickly and affordably. 

If you have Optum EAP benefits and are currently seeing an Alma provider either out-of-pocket or in-network with Alma’s insurance program, you may be able to apply your EAP coverage to anywhere between 3 and 10 sessions (depending on your benefit) with Alma. Note that some mental health services are not covered under EAPs, so discuss this option with your Alma provider to make sure it is a good fit for you.

How do EAPs typically work?

Access to services

Unlike traditional insurance, where Alma reaches out directly to your health plan to verify that your provider is in-network with your benefits, EAPs give you the agency to verify your own eligibility for benefits. 

To apply your EAP benefits to sessions, you will need 3 things:

• A client EAP authorization code
  A  unique code that you can use to apply EAP benefits to specific provider visits.
  
  
• Eligible sessions 
  The total number of visits authorized by your for EAP coverage. These range from 3-10 visits, with 5 being the most common.
  

• Benefit effective dates: 
  The active dates of your EAP eligibility. For example, you could have 5 EAP visits to use within a benefit year of July - June.

If you have an Optum EAP benefit, you can request this information by either calling 866-374-6060 or creating an account and signing in with Optum’s EAP website: www.liveandworkwell.com.

You can also find step-by-step instructions for working with Optum's website here: What you need for your first EAP visit. 

Please note that Alma cannot gather this information directly. You will need to reach out to Optum to request benefits information and then share it with your provider to add to the Alma portal. 

Session cost

A major advantage of EAP visits is that they are entirely free for you as a client. All costs are covered by the employer, and there is no copay, coinsurance, or deductible for services. 

Services covered

EAPs cover a limited range of mental health services, including 30- and 45-minute psychotherapy appointments, couples and family therapy, and group therapy. EAPs will not cover longer therapy sessions or medication management. 

If you already see an Alma provider and you want to use your Optum EAP benefits, check in with them first to make sure that your needs will be covered under your EAP. 

Summary: EAPs vs. traditional health insurance

Can I keep seeing my Alma provider after my EAP benefits have ended?

Yes! If you and your provider want to keep working together beyond your covered EAP sessions, you have several financial options to continue care:

• If you have an active health plan, you can share your insurance details with your provider. They can add your health plan details to the Alma portal to verify eligibility. Following the eligibility check, you and your provider will receive an email from Alma letting you know if your health plan is in- or out-of-network.
  
• If your plan is in-network with Alma’s insurance program, then you will be able to see you provider with the copay or coinsurance set by your health plan.
  
  
• If your plan is out-of-network with Alma, you can see your provider at a private pay rate you agree to with them. You will receive regular invoices and superbills, which are monthly statements of care received.
  
  You can also reach out to your health plan directly to  ask about out-of-network benefits. You may still be able to use your Alma superbills to get reimbursement from your health plan for some of your session costs.
• If you do not currently have insurance, then you can see your provider at their agreed-upon private rate for sessions.

You can also review your options for working with your Alma provider after EAP here: Continuing care beyond my EAP benefits.

Can I check if my insurance is in-network with Alma before I finish my EAP benefits?

Yes! To get a preliminary quote of session costs, you can use the Alma website’s cost estimator tool. Simply enter your health plan name (for example, Aetna, Cigna, or Oscar) and your member ID number, and our site will give you a general estimate of what you can expect to pay.

Once you have completed your EAP benefits your provider, they can enter your health plan information into the Alma portal for a more formal verification. This eligibility check through the portal is more detailed than our cost estimator tool, so it will give an updated quote for your costs per session.

You can also use the phone number on the back of your insurance card to contact your health plan and verify your benefits and network status with Alma.