An Employee Assistance Program is a workplace benefit program designed to support employees with personal problems or issues that may affect their well-being, job performance, or overall productivity. EAPs typically provide confidential counseling services, referrals to specialized resources, and assistance in addressing various concerns such as mental health issues, substance abuse, stress management, financial difficulties, and work-life balance.
Whenever the topic of EAP is raised, a frequently asked question is what is the difference between EAP and Worker’s Compensation Program?
Let’s have a brief overview of the differences between both.
| Employee Assistance Program | Worker’s Compensation Program |
| Purpose | |
| Employee Assistance Program focuses on providing confidential counseling and support services to employees dealing with personal issues that may impact their well-being and job performance. It typically covers a broad range of concerns such as mental health, substance abuse, financial problems, and work-life balance | Worker’s Compensation is a form of insurance that provides benefits to employees who suffer work-related injuries or illnesses. It aims to cover medical expenses, wage replacement, rehabilitation services, and disability benefits for employees injured on the job |
| Coverage | |
| EAP services are available to all employees, regardless of whether the issue is work-related or personal. It is a voluntary program offered by employers as a supportive resource for their employees | Worker’s Compensation covers employees who sustain injuries or develop illnesses directly related to their job. It is a mandatory program mandated by state or federal laws and is typically administered by insurance companies or government agencies |
| Eligibility | |
| EAP services are generally available to all employees, including full-time, part-time, and contract workers. Eligibility criteria vary depending on the specific EAP program offered by the employer | Employees who experience a work-related injury or illness are eligible for Worker’s Compensation benefits. The eligibility requirements may vary by jurisdiction and are typically based on factors such as employment status, the nature of the injury/illness, and adherence to reporting procedures |
| Claims and Billing | |
| EAP services are typically not billed through insurance. They are often funded entirely by the employer or a third-party EAP provider contracted by the employer | Medical providers treating an employee’s work-related injury or illness can submit claims to the Worker’s Compensation insurance carrier for reimbursement. The billing and reimbursement process follow specific guidelines set by the insurance carrier and relevant laws |
In summary, EAP focuses on providing counseling and support for various personal issues affecting employees’ well-being. In contrast, Worker’s Compensation primarily deals with compensating employees for work-related injuries or illnesses. They have different eligibility requirements, coverage scopes, and billing processes.
How does the billing process of EAP work?
Different insurance carriers accept EAP claims i.e. Optum, United Health, Cigna, and Aetna. Some of these carriers allow electronic claims submission but some still may require to mail the claim in a paper form they provide.
If the EAP accepts the electronic submission of claims, the process is almost identical to submitting a typical claim, for example,
- Cigna requires the CPT code 99404 for the indication that an EAP claim is being submitted
- Furthermore, electronic submission of such claims requires an authorization number as well
Just like other claims, these processes can differ based on the insurance carriers.
