A broker’s guide to clarifying mental health coverage for HR and employees
One of the most common questions HR teams get—especially during open enrollment—is this: “What’s the difference between our EAP and our mental health insurance benefits?”
As a broker, being able to answer this clearly not only supports your clients—it positions you as a trusted advisor in mental health benefit strategy.
What the EAP Covers
Employee Assistance Programs are designed to provide short-term, immediate support for everyday challenges. They are:
- Free to the employee (no co-pays, claims, or out-of-pocket costs)
- Confidential (not connected to insurance or HR notifications)
- Quickly accessible (often same-day or next-day appointments)
Common EAP services include:
- Short-term counseling (typically 3–6 sessions per issue)
- Legal and financial consultations
- Work-life resources (childcare, elder care, daily living)
- Life coaching and wellness tools
- Support for household members
What the Medical Plan Covers
Your health insurance plan provides ongoing or clinical care for diagnosed mental health conditions. It typically includes:
- Longer-term therapy or psychiatry (often with copays or deductibles)
- Specialist services (psychologists, psychiatrists, in-network providers)
- Medication management
- Outpatient/inpatient mental health treatment
Access often requires more steps, like scheduling with in-network providers, getting referrals, or waiting weeks for availability.
When to Use One vs. the Other
Help clients guide their employees with this simple decision matrix:
| Situation | Start with EAP | Use Medical Plan |
|---|---|---|
| Feeling overwhelmed, stressed, or burnt out | ✓ | |
| Need help finding child or elder care | ✓ | |
| Looking for legal/financial advice | ✓ | |
| Want quick access to talk to someone | ✓ | |
| Ongoing depression or anxiety diagnosis | ✓ | |
| Need long-term therapy or medication | ✓ |
How to Position Them as Complementary
They’re not either/or. The EAP and the medical plan should work together:
- The EAP acts as a front door—offering immediate help and guidance
- If long-term care is needed, the EAP can refer into the medical plan
- EAP removes financial and logistical barriers, encouraging early intervention
Use this guide to help your clients:
- Educate HR teams and employees about how to navigate both benefits
- Reduce confusion and underutilization
- Promote the EAP as a no-risk, confidential starting point