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Employee Assistance Programs (EAPs)
Employee assistance programs (EAPs) are work-based intervention programs connecting employees with resources to address personal problems. They include services such as mental health counseling, substance use disorder counseling, financial advising, legal services, and family-related issues. EAPs are typically offered at no cost to employees by third-party vendors or as part of an employer’s group medical plan.
Medical Benefits
EAPs often provide medical care, such as counseling by trained professionals. EAPs offering medical care are considered group health plans subject to compliance requirements under ERISA, COBRA, HIPAA, and the Affordable Care Act (ACA). Employers offering high deductible health plans (HDHPs) should consider how an EAP may impact eligibility for health savings accounts (HSAs).
Compliance Requirements for EAPs
EAPs offering medical benefits are subject to various compliance regulations. Key areas include:
ERISA Compliance
EAPs providing medical benefits must meet the minimum standards of ERISA, which include adopting plan documents, providing a summary plan description (SPD), and filing an annual Form 5500 report.
COBRA Compliance
EAPs considered group health plans must comply with COBRA’s continuation coverage requirements in case of qualifying events.
HIPAA Privacy and Security
EAPs are subject to HIPAA’s privacy and security rules. Employers with self-insured EAPs must implement appropriate safeguards and comply with HIPAA requirements.
ACA Market Reforms
EAPs providing significant medical care benefits are considered group health plans under the ACA. Stand-alone EAPs must meet certain criteria to qualify as excepted benefits.
HSA Eligibility
EAP coverage must not provide significant medical care to maintain HSA eligibility.
Mental Health Parity
The Mental Health Parity and Addiction Equity Act (MHPAEA) prevents group health plans from imposing less favorable limits on mental health benefits compared to medical and surgical benefits.
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This overview is for informational purposes and should not be considered legal advice.
Marty Thomas
Marty has spent most of the last 20 years developing software in the marketing space and creating pathways for software systems to talk to each other with high efficiency. He heads our digital marketing efforts as well as oversees any technology implementations for our clients. As a partner, Marty is also responsible for internal systems in which help our team communicates with each other and our clients.