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 two EAPs through Optum: 

If you are enrolled in either the Live & Work Well Employee Assistance Program or Emotional Wellbeing Solutions through Optum, you can find more about your benefits by logging into Optum's Live and Work Well website.

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

Typically, EAPs give you the agency to verify your own eligibility for benefits.* This means that, unlike traditional insurance. where Alma verifies your insurance information directly with your health plan, most EAPs require you to gather the following information directly from the health plan to confirm your benefits:

  • 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 are enrolled in Optum's Live & Work Well EAP, you can request authorization codes and other EAP information by creating an account and signing in with Optum’s EAP website: www.liveandworkwell.com.

*Please note: The above access requirements do not apply to Optum's premium EAP, Emotional Wellbeing Solutions. This premium EAP offers a streamlined experience, so that you can log directly into Optum's website to view a specialized directory of Alma providers who have already been confirmed as in-network with your benefits. Your eligible number of sessions and benefit effective dates will be automatically transferred to your Alma provider when you start care with your Emotional Wellbeing Solutions sessions. 

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

 

EAPs 

Traditional Insurance

# of visits

  • 3-10, based on employer
  • Unlimited

Client payment responsibility

  • None — EAPs fully cover the contracted rate for visits 
  • Copay, coinsurance, or deductible

Access to services

  • Client will need an EAP authorization code 
  • Open access, based on Alma’s eligibility checks

Covered services

  • 30-minute psychotherapy, 45-minute psychotherapy, family or couples therapy, group therapy
  • All contracted services

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 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.

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