October 11, 2023
What is an EAP?
An EAP is a general term for a voluntary, work-based program that can offer a wide array of low-cost/no-cost support, education, and planning services for employees and their families. For health and well-being EAPs, it is common to provide free and confidential assessments, short-term counseling, referrals and follow-up services to employees who have personal and/or work-related problems.1 EAPs can address a broad and complex body of issues affecting mental health and emotional well-being, such as alcohol and other substance use, stress, grief, family problems and psychological disorders. According to the 14th Annual Employer-Sponsored Health & Well-being Survey, 97% of employers offer an EAP in 2023.2
For additional information and considerations related to employer approaches to creating a comprehensive mental health strategy, see Engineering Mental Health: Building a Strategy from the Ground Up.
Who are the major EAP vendors?
While the Business Group does not promote or endorse any specific vendors, many employers use EAP services offered by their health plan carriers. Others choose to partner with other vendors to provide EAP services, including, but not limited to, the following:
Outside the U.S.
Chestnut Global Partners
GMK/TCK EAP Korea
What are newer EAP models or “alternatives” and how are they different from traditional EAPs?
In recent years, newer alternatives to longstanding EAP providers have gained traction. In 2023, 34%of employers utilize a newer EAP model and another 25% are considering doing so by 2024. Newer EAP models tend to have digitally-focused offerings, including assessments that determine the level of recommended care, self-service tools and resources, virtual or in-person coaching or counseling and asynchronous communication with providers. Many of these newer EAPs have smaller, curated networks of providers and enable employees and their family members to select a provider and book appointments directly through a platform, increasing ease and access to care.
In the U.S.
All One Health
Carelon Behavioral Health
Mercy Managed Behavioral Health
Unum Behavioral Health
UHC Behavioral Health
The newer generation of EAPs has gained traction with employers and the workforce because their digital-first focus reduces barriers to accessing care, drives down time to care, and increases their ability to track the impact of care through regular patient surveys as a part of the patient experience online. Given their relatively new arrival as compared to legacy providers, they may have less of a track record to show long-term outcomes.
How many visits do companies generally offer?
The number of EAP visits covered by employers varies. According to a Business Group on Health survey conducted in 2022, all 75 employer respondents had an EAP visit maximum in place, with 73% reporting a per incident maximum and 27% reporting an annual maximum. In many cases, an EAP is designed to fit into a legal status called an “excepted benefit” that limits the amount and nature of the services covered. Visit limits are generally one factor in maintaining an excepted benefit EAP and any changes to an EAP should be mindful of potential impact to that status. (See below for more on legal considerations).
Among employers with an annual EAP visit maximum, the average visits covered was 10, with a range from 3 to 25 visits.3 Among employers with “per-incident” visit limits, the average was 6 visits per-incident, with a range between 3 and 12. Both of these visit limit figures increased from years prior to the COVID-19 pandemic, as 77% of employers saw an increase in mental health needs in 2023.4,5
Employers interested in expanding their EAPs to recognize the importance of mental health and enable the best level of support for employees and their families should assess the number and type of sessions allowed annually, which may be higher than what is currently offered. Assuming no issue with the legal status of the EAP, increasing the number of allowed visits can greatly benefit plan members who need the aid of additional visits, while representing a relatively small budget impact because most employees will not need the maximum number of free visits covered. This will depend on your reimbursement model (see text box.) According to one survey of EAP providers, the average number of “visits” used per participant, per-incident went from about 3 in 2019 to over 5 during the height of the COVID-19 pandemic in 2021. Longer-term data will reveal if this utilization reverts to pre-pandemic rates.6
Budget Impact of EAP Visit Increases Depends on Reimbursement Model
EAPs generally offer different reimbursement models based on what the employer client desires. One is akin to “fee-for-service”, where the employer pays for each individual visit. For general medical services, this is generally understood to be a bad approach, but given that mental health services are widely underutilized, it can prevent employers from overpaying for services. A “subscription model” where employers pay a set rate per employee based on their visit limits creates more budget certainty, but potentially leads to employers paying for more visits than are utilized.
What is the average utilization rate for EAPs? What do the top performing companies achieve?
Typically, the percentage of the workforce that utilizes the EAP hovers in the single digits, with many employers reporting low engagement rates as a top challenge related to their EAP. However, the COVID-19 pandemic increased utilization and on average, 12% of eligible employees accessed EAPs through their employer in 2021.7 Success in driving EAP utilization rates varies widely, with some employers seeing just 1% utilization, while the highest reported rate was 50%.8 Despite these increases, the longer-term impact of the pandemic on EAP utilization is yet to be determined. Integrating the promotion of the EAP into other health and well-being benefits and tools may also help increase utilization, which is generally viewed as a positive outcome given the unmet need of the increasing mental health challenges across the globe. Success, ultimately, should be measured by both utilization, but also surveys and outcomes data to gauge whether patients’ needs were met.
Should my branding strategy emphasize the mental health components of an EAP or focus on work/life support to drive utilization?
There is no correct answer to this question and it will likely depend on the company’s culture, workforce demographics, and location. A number of employers have rebranded their EAP to change employee perception, remove possible stigma and align the program with the organization’s mission and goals. Examples of rebranded names include “Work Life Solutions,” “Your Life Matters” and “LifeMatters.®” As a part of this rebranding, employers are promoting the full scope of EAP benefits, from core services like mental health counseling, to the often less well-known services such as financial, legal, child and elder care assistance. One Business Group member, for example, is marketing its EAP by communicating the positive reasons employees might use it, such as for career development. Marketing the full scope of EAP services also enables employers to integrate its promotion into other health and well-being communications or tools (i.e., well-being platforms) to help keep the EAP top of mind for employees and their families.
Other employers have taken the stance that they shouldn’t shy away from the fact that the EAP is intended to be a support for mental health, and have branded it accordingly. Stigma around mental health has decreased in recent years, and Gen Z/Millennials report lower rates of stigma than older generations.9 For more information about communicating about mental health and substance use disorder that destigmatizes those experiencing them, see the Business Group on Health resource, Engineering Mental Health: Building a Strategy from the Ground Up.
What digital capabilities do EAPs offer?
EAPs often have several digital capabilities, including:
- Digital questionnaires that triage care or offer recommendations
- Online provider directories and booking through websites and apps
- Live video coaching or counseling
- On-demand, self-guided exercises
- App-based messaging with providers
Such digital capabilities may increase access to care and improve the employee experience with the EAP.
Should I bring EAP services on-site? What are some benefits or drawbacks to this strategy?
According to Business Group on Health’s 2024 Health Care Strategy Survey, 63% of employers will offer on-site or near-site EAP in 2024. Bringing the EAP on-site may improve utilization by increasing convenience, particularly for those locations that have employees with longer commuting times, and employee familiarity with and confidence in its services. On-site services may also allow employers to align the EAP with their organizational culture by hiring EAP counselors for fit and educating them on company policies, practices and norms, along with available benefits and programs. On that note, an on-site EAP may enable greater coordination and/or referrals to other available services. Companies with an on-site EAP report good utilization. Potential drawbacks to bringing the EAP on-site include cost, scalability and the potential perception of inequity among those without access.
What have other employers done to bolster their partnership with their EAP provider?
Employers should set clear expectations from the beginning, including the EAP’s role in supporting employees across the continuum of mental health and well-being needs, as well as how the EAP will integrate with other vendors.
Additional strategies to strengthen the relationship between an employer and EAP provider include:
- Agreeing on EAP reporting metrics and frequency, establishing key performance measures such as wait time for counseling (the average is 4.9 days to obtain a counseling session), utilization rate, baseline assessment and clinical outcomes, duration of treatment, therapeutic alliance, and percent of cases resolved.10
- Discussing how the EAP will be communicated across the population, identifying possible utilization barriers and partnering on solutions.
- Inviting employee feedback and incorporating this into regular performance reviews with the EAP provider.
- Including the EAP in vendor summits and ensuring that counselors are aware of and able to refer across the employer ecosystem in addition to making community referrals.
- Inviting the EAP to provide recommendations on how to improve reach and impact.
- Clarifying “critical incident” definition and related policies.
Do EAPs offer peer and manager trainings? Are they effective?
Many EAP providers conduct peer and manager training on a variety of topics. Although research shows that training may have a positive impact, none of the studies were specific to training conducted by an EAP. Employers interested in peer and manager training should ask their EAPs if they offer it and if they have outcomes data associated with both kinds of training. For more information on manager and peer training, see the Business Group on Health resource, Engineering Mental Health: Building a Strategy from the Ground Up.
If I have an EAP, do I need to invest in additional mental health vendors? How much overlap is there?
The intake, counseling and referral services provided by an EAP will generally not be sufficient to meet the full range of mental health needs within your population. Ideally, your EAP will provide a welcoming front door on a range of issues, including effective assessment and referral to specialized resources that can address many common problems:
- Financial concerns;
- Legal concerns;
- Alcohol and substance use;
- Family and relationship problems;
- Interpersonal conflict with a manager or colleague;
- Eating and sleep disorders; and
- Anxiety, depression and other mental health disorders.
Many times, services and treatments that are longer-term or more substantial than can be directly provided under an EAP will be provided by the employer’s medical coverage under its health plan. Common additional services, including some under a health plan, that employers offer with their EAP include:
- Curated network of specialty mental health providers and facilities;
- On-site counseling;
- Telebehavioral health care (virtual visits); and
- Apps for cognitive behavioral therapy, happiness, sleep, behavior change, etc.
There may be some overlap between the services an EAP offers and other mental health vendors covered under the medical benefit. Employers considering consolidating their EAP and mental health offerings under the medical benefit should pay attention to which service is currently seeing more demand, whether access is currently easier in either path, the employee experience for each channel, costs of consolidating or expanding services, and the ability of each to address particular patient needs (e.g., diversity of providers, language(s) beyond English, pediatric or other specialized skills.) Some apparent redundancy may be warranted to offer employees choice and ensure capacity at times of peak need.
What capabilities do EAPs make available for employees with substance use disorders?
There are several things an EAP is generally able to do to support employees or their families experiencing substance use disorders:
- Identify providers for inpatient and outpatient services that provide evidence-based treatments, including all three major forms of medication, and help determine in-network or out-of-network status under the employer’s health plan, as applicable.
- Navigate people with substance use disorders, or often their families, to appropriate therapy.
- Provide crisis support for plan members when they need quick access to intensive treatment for serious substance use episodes.
- Maintain support for employees who are under “first offense forgiveness” policies. These policies, put in place by many employers, state that employees with substance use disorders who experience condition-related job performance issues will not be terminated upon a first offense, but are instead diverted to the EAP. For these employees, their continued employment is contingent upon getting professional help for their condition; this help can be directed and monitored by the EAP.
What legal considerations should I keep in mind when crafting my EAP strategy?
Many employers design the EAP to qualify as an “excepted benefit,” which is subject to fewer design and compliance requirements than a full “health plan” would be. In order to qualify as an excepted benefit, an EAP has to meet several requirements under federal rules. In general, the EAP would be prohibited from providing “significant benefits in the nature of medical care,” must not charge premiums or apply cost-sharing, and abide by other restrictions around coordination/participation with other group health coverage.
Therefore, when evaluating EAP vendors or designs, employers should consider working with consultants and legal counsel to help ensure the proposed EAP meets the employer’s expectations with respect to excepted benefit status. Common factors to gather information on when considering a potential excepted benefit EAP include:
- Precise description of the types of benefits are included in the EAP.
- If the EAP offers mental/behavioral health counseling sessions, the number, duration, and objectives of the sessions.
- The impact and design of any medical telehealth services.
- Other medical and/or health-type benefits available through the EAP.
- The vendor’s representation of the EAP as an excepted benefit.
- Any substantiation, assurances, and/or guarantees the vendor will provide relating to the EAP’s status as an excepted benefit.
What RFP questions should I include for EAPs?
- In what languages is your Web portal available? Are online materials culturally appropriate for employees? If so, where?
- Please outline your global technological capabilities outside of your website (apps, instant messaging/chat, video counseling, AI, etc.). How do you use these to help people access services in a confidential manner when and where they need to?
- What data privacy and transfer issues/laws are relevant in our company locations?
- Are your providers licensed in all 50 states to provide coverage to all U.S. employees?
- In which countries are providers licensed to practice?
- Does your EAP have an app and what capabilities are offered through it?
- What are your minimum requirements for both counselors and intake staff? If this varies by country, please detail those differences.
- How many affiliate providers do you have in each of our locations (by city and country if possible)?
- In which countries do you have your own staff versus in which countries do you have affiliates/subcontractors?
- What is your training process for new and existing employees and affiliates? How do you ensure global consistency in your training for network affiliates?
- Do you have continuing education requirements for your employees and affiliates? If so, what does this involve?
- Please provide a listing of your global affiliates.
- In which of our countries do you not offer face-to-face capabilities? How will you meet employee needs in those locations? Please explain your system for referring employees to community providers once EAP services are exhausted. What do you do in countries where there are no appropriate community providers or where they are prohibitively expensive?
Data collection, reporting and measurement
- How do you evaluate the effect of EAP on organizational performance (productivity, disability, engagement, absenteeism, retention, etc.)? Can you quantify this?
- How can we benchmark the success of our program versus other companies in your book of business?
- How often will market-level, regional and global reports be available and in what timeframe? For example, how soon after a quarter closes will we receive a quarterly report?
- Can you provide examples of market-level, regional and global reports?
- How do you count utilization, and what types of utilization statistics do you include in your typical reports?
- How do you measure the effectiveness of the mental health/substance use disorder services (e.g., symptom improvement or resolution, patient satisfaction, etc.) and what results have you achieved?
- What services do you offer for critical incidents and crises (e.g., natural disaster, employee death, workplace accident, etc.)? Are there additional costs for these services? Who provides the services, and where are they located?
- Do you currently provide on-site therapists for other large employers? If so, in which countries? What is the average utilization rate by region for your book of business?
- Do you recommend providing on-site services in certain locations and why?
- What is the cost differential for providing EAP services on-site?
- How many global clients are you currently serving and in which countries?
- Please describe the laws and regulations that affect your EAP offerings in the countries in which we have operations (e.g., where are you most limited? Where do you need to take very different approaches)?
- Can you give specific examples of regional/country/cultural differences in service delivery that are applicable in our top 5 or 10 locations?
- Please walk me through exactly what would happen from the time a potential client called the EAP in our top 2 or 3 locations to the time they finished receiving services. Who would answer the phone and in what language? What type of mental health treatment would they receive (if applicable)? How would their progress be monitored?
- What types of cross-cultural training can you provide for both local hires and expatriates in order to help them work together successfully?
- Please give a few recent examples of how employers have tailored your EAP to meet their specific needs.
- What emerging issues do you see in global EAPs that we should be aware of?
- What are you doing to address barriers such as access and stigma in particular countries?
- Are calls answered in a regional call center or locally in each country? Is there a toll-free number available in all of our locations?
- Please outline your wellness/well-being capabilities globally. Specifically outline which services are available in our top 2-3 locations and how exactly those services are provided.
- How do you provide services for expatriates and their families (e.g., preparation for trip, while on assignment and preparation for returning home)? Are these proactive or reactive services?
For more information on global EAPs, see the Business Group on Health resources Global EmployeeAssistance Programs Guide.
Which EAP vendors have global capabilities and what questions should I ask them about their capabilities?
A “global EAP” means different things to different people. A list of EAPs that operate outside of the U.S. is listed at the beginning of this resource. Typically, employers either implement a single global EAP supplier or utilize a variety of regional or local vendors around the world. Even when they contract with one global vendor, that may be with a vendor that has operations or contracts with providers around the world or it may be with a domestic, U.S.-based provider or health plan that then establishes a contract with a global provider. See the Business Group on Health resource 6 Key Considerations When Assessing Global Capacity of Mental Health Providers to learn more.
What should employers keep in mind when implementing globally?
EAPs can be an essential offering in countries where there is little access to mental health and work/life services, and it’s imperative to understand the varying challenges associated with offering services around the globe. Employers who have well-utilized EAP programs say that the following best practices have led to their success:
- Involve local leadership and staff early to get buy-in. This may be in the form of an EAP committee, ambassadors/champions or informal feedback. It is important that the local site leaders feel as if they have a voice in the decision. Partnering with local leaders may also assist in combating any unknown biases or stigmas that exist in the culture.
- Adhere to local legal and labor requirements. You may need to engage with legal counsel and local labor and employee relations when implementing the EAP locally.Depending on contracts, you may need to notify, inform or consult with unions or works councils before communicating and implementing.If you are implementing the program across several European countries, this could trigger requirements with the European Works Council in addition to country and local work councils.
- Understand provider availability. Require the vendor to share the depth of their network as well as any local issues related to licensing and standards.
- Adjust your communications to fit local culture and content. Your communications should be flexible and culturally adaptable in order for them to be successfully received by the intended audience.
- Familiarize employees with the program and make sure it is easy to access. Helping employees understand what an EAP is and does, putting a face to the EAP provider’s name and ensuring that it is easy to use may help encourage employees to take advantage of the program.
- Work with your vendor to ensure digital solutions are available in the local language and culturally relevant. This is true for other services as well. All programs should be viewed as local and be personalized to the needs of a specific location or business. Needs can be identified through focus groups, employee surveys or informal conversations. It is crucial that an EAP provider understand these needs and provide services, as well as employ locally based counselors who understand the culture.
- 1 | OPM. Frequently asked questions: Work life. https://www.opm.gov/faqs/QA.aspx?fid=4313c618-a96e-4c8e-b078-1f76912a10d9&pid=2c2b1e5b-6ff1-4940-b478-34039a1e1174. Accessed May 7, 2020.
- 2 | 14th Annual Employer-Sponsored Health and Well-being Survey: Well-being’s Path Forward. Business Group on Health & Fidelity Workplace Consulting. May 2023. https://www.businessgrouphealth.org/resources/14th-annual-health-and-well-being-survey-2023
- 3 | Business Group on Health. Quick survey findings: Employee Assistance Programs in 2022. https://www.businessgrouphealth.org/resources/quick-survey-findings-employee-assistance-programs-in-2022
- 4 | Business Group on Health. Quick survey findings: Employee assistance programs. May 2019. https://www.businessgrouphealth.org/-/media/bgh/documents/download-pdf/quick_survey_findings_employee_assistance_programs.pdf. Accessed May 7, 2020.
- 5 | Business Group on Health. 2024 Large Employer Health Care Strategy Survey. August 2023. Available at: https://www.businessgrouphealth.org/resources/2024-large-employerhealth-care-strategy-survey-intro
- 6 | Attridge M. EAP and COVID-19 2021: Trends in Workplace Mental Health During the COVID-19 Pandemic: Implications for Vendors of EAP Services. Presentation to The Workplace Collaborative Virtual Conference. September 22, 2021. Accessed September 11, 2023. https://archive.hshsl.umaryland.edu/handle/10713/16887
- 7 | Business Group on Health. Quick survey findings: Employee Assistance Programs in 2022. https://www.businessgrouphealth.org/resources/quick-survey-findings-employee-assistance-programs-in-2022
- 8 | McBain R, Cantor J, Pera M, et al. Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic. January 2023. JAMA Health Forum. 2023;4(1):e224936
- 9 | Greenwood K, Bapat V, Maughan M. Research: people want their employers to talk about mental health. November 22, 2019. Accessed August 24, 2023. https://hbr.org/2019/10/research-people-want-their-employers-to-talk-about-mental-health
- 10 | Business Group on Health. Quick survey findings: Employee Assistance Programs in 2022. https://www.businessgrouphealth.org/resources/quick-survey-findings-employee-assistance-programs-in-2022