Module 9 Managing Employee/Member Assistance and Wellness Programs Flashcards
Describe the characteristics of an employee assistance program (EAP) or member assistance program (MAP).
An EAP is a service designed to assist with personal or family problems, including mental health, substance abuse, various addictions, marital problems, parenting problems, emotional problems, and financial or legal concerns.
They are typically provided by plan sponsors to their employees/plan members to assist them in getting help for these types of problems so that employees may remain at work and effective. EAPs originated with a primary focus on drug and alcohol abuse with an emphasis on rehabilitating valued employees rather than terminating them for their substance abuse problems. Over the years, EAPs expanded to incorporate not only mental health and substance abuse issues but also health and wellness and work/life balance concerns. EAPs are also called employee and family assistance programs (EFAPs). When a union or other member-based association sponsors an EAP, it may be called a MAP.
Although most commonly offered to plan members and their family members, EAPs can also offer services to the plan sponsor organization. These may include conflict management as well as prevention, training, consultation, organizational development and crisis response services.
Explain the premise that underpins EAPs and the objectives that EAPs serve in an organization.
EAP design is based on the premise that there is a direct link between an individual’s well-being and productivity. Employees experiencing workplace or personal issues are prone to increased absenteeism and presenteeism (i.e., attending work while sick, injured, anxious, etc.), often resulting in decreased productivity. These employees also typically have more serious on-the-job accidents. This increases the costs of extended health care and disability benefits, lowers employee morale (since co-workers must often assume some of these employees’ work) and increases staff turnover, all of which have a negative impact on the employer’s bottom line and benefits costs.
EAPs can serve these objectives:
(a) Promoting workplace health and wellness and increasing plan members’ awareness of the importance of their well-being and of the resources available to assist and support them in maintaining health and wellness
(b) Providing plan members who have personal or workplace difficulties with voluntary and confidential access to professional services, with the goal of resolving problems before they negatively affect job performance
(c) Providing plan sponsors with an alternative to normal disciplinary procedures for employees whose job performance has declined due to a serious problem and who may be unwilling or unable to take advantage of preventive resources. In many cases, EAPs can save otherwise productive and talented individuals from termination through mandatory referrals to the EAP as part of a performance improvement plan.
(d) Adding value to the benefits package to make it more competitive, thereby aiding in attracting and retaining employees
(e) Supporting plan sponsor initiatives to manage and reduce short-term absences as well as short- and long-term disability incidence and benefits costs as part of a broader health and productivity management strategy.
Explain the role of EAPs in shielding a plan member who accesses an EAP from disciplinary action if they are unable to satisfactorily perform a job.
While an EAP is designed to assist plan members with problems that affect their job performance, plan members are still responsible to perform at an acceptable level. The use of an EAP does not shield them from disciplinary action when it is required; nor should the use of an EAP impact their job security or chances for promotion.
Identify factors that influence a plan sponsor’s choice of services to offer in its EAP.
Plan sponsors should tailor EAPs to meet plan members’ needs. Therefore, an understanding of the workplace is important, including an analysis of:
(a) Type and level of benefits in existing benefit plans
(b) Plan sponsor’s health and productivity objectives
(c) Plan sponsor’s management practices
(d) Socioeconomic issues affecting plan members or the workplace as a whole
(e) Stresses and nature of the work particular to the plan sponsor organization or industry
(f) Diversity and inclusion needs and issues
(g) Plan member physical and emotional health needs and issues
(h) Legislative landscape and employer responsibilities that specifically relate to mental health.
Describe the legislative landscape that informs employer responsibility for mental health and safety.
The legislative landscape that specifically relates to mental health includes regulations related to occupational health and safety, worker’s compensation, human rights, employment standards and labour relations as well as standards with respect to employment contracts.
In short, the responsibility employers have with respect to physical health and safety also relates to mental health and safety. One effort to specifically address these responsibilities has resulted in a national standard for psychological health and safety in the workplace.
Outline the guiding principles of the National Standard of Canada for Psychological Health and Safety in the Workplace.
The National Standard of Canada for Psychological Health and Safety in the Workplace is based on these guiding principles:
(a) Legal requirements associated with psychologically healthy and safe workplaces applicable to the organization are identified and complied with as a minimum standard of practice
(b) Psychological health and safety is a shared responsibility among all workplace stakeholders and commensurate with the authority of the stakeholder
(c) The workplace is based on mutually respectful relationships among the organization, its management, its workers and worker representatives, which includes maintaining the confidentiality of sensitive information
(d) Individuals have a responsibility for their own health and behaviour
(e) There is a demonstrated and visible commitment by senior management for the development and sustainability of a psychologically healthy and safe workplace
(f) There is active participation with all workplace stakeholders
(g) Organizational decision making incorporates psychological health and safety in the processes
(h) A primary focus on psychological health, safety, awareness and promotion as well as the development of knowledge and skills for those persons managing work arrangements, organization, processes and/or people.
Describe the basic types of services that can be included in an EAP.
The basic types of services delivered to plan members and their covered dependents included in an EAP are:
(a) Crisis intervention (access, intervention and intake), including 24/7/365 immediate live response through appropriate delivery methods such as traditional telephone and/or in-person counselling services as well as digital methods (e.g., chat counselling, video counselling), access to crisis response teams and referral to community-based emergency services, as appropriate
(b) Short-term, professional counselling services, including assessment, diagnosis, information, education and solution-focused treatment for personal and emotional issues (e.g., relationships, mental health and addiction) through face-to-face sessions or online communication through email, instant messaging or video chat as well as online self-directed learning
(c) Referrals to long-term counselling for issues that cannot be resolved with short-term counselling
(d) Short-term work/life concierge-style services, including assessment, education and solution-focused advice for issues such as nutrition, financial support, legal advice, career planning, separation and divorce, child care and elder care
(e) Triage/referral to long-term support services and referrals that provide intensive extended treatment for covered individuals with more complex issues
(f) Referrals to self-help groups or community-based services that provide ongoing support for a specific problem (e.g., second opinions for medical issues, disability matters, specialized case management and coaching related to chronic disease).
Describe how EAP providers determine eligibility for plan benefits.
The plan sponsor determines eligibility for EAP services, and eligibility can vary widely but, typically, the plan member, spouse or common-law partner, and dependents up to age 21 (or, if the dependent is engaged in full-time studies, up to age 25) qualify. Because of the nature of the services provided, EAPs typically use “presumed” eligibility when contacted and follow up afterwards to confirm eligibility against plan member eligibility lists the plan sponsor provides.
Describe the three types of EAP referrals.
The three types of referrals to EAP services are:
(a) Self-referral, through which plan members and/or their dependents voluntarily refer themselves
(b) Guided referral, through which a family member or other source can encourage the use of EAP services. Supervisors may use this approach when an employee appears to be having personal or work-related difficulties, but the issue does not warrant mandating that the employee use EAP services.
(c) Mandatory referral, through which a supervisor can formally request that an employee use EAP services. Mandatory referrals usually occur when the presenting issue relates to work issues, substance abuse or other behavioural conduct that is affecting productivity or safety.
Identify challenges associated with delivering an EAP on an in-house basis.
In-house delivery of an EAP presents some challenges:
(a) It requires a significant investment in facilities, human resources (HR) and technology resources to design and maintain programs and to provide the required service quality and confidentiality assurances. Not all plan sponsors have enough demand for services nor the resources to hire and maintain qualified staff. As a result, in-house delivery may not be viable from a cost-benefit perspective.
(b) It is more challenging to protect confidentiality. Real or perceived lack of confidentiality within the program management team and from coordinators or counsellors can endanger the success of an EAP. Whether services are delivered face-to-face or digitally, some plan members prefer externally provided coordinators or counsellors to protect their privacy.
Outline benefits of providing an EAP on an external basis
Benefits of an external EAP delivery model include:
(a) It facilitates protection of confidentiality. Working with an external, unbiased provider creates perceived and actual privacy (i.e., separation between the organization and plan members’ personal issues). Covered individuals access services outside the workplace through third-party clinicians/professionals. An external provider can offer a wider network of in-person offices for assistance as well as more service delivery options, which offers greater discretion and flexibility.
(b) It can provide more specialized support options. Most external providers have extensive networks of clinical and support staff that offer more specialized support (e.g., marriage and family counsellors as opposed to generalists). They can also better accommodate counsellor and language preferences.
(c) A larger and more specialized staff can provide faster and more targeted service. Guaranteed support through a 24/7/365 intake service can prioritize urgent or crisis situations.
(d) External providers may provide additional supports/auxiliary services such as monthly manager and plan member newsletters, a website or other resources targeted at addressing issues that aren’t necessarily of a critical nature but keep members healthy (e.g., online wellness education and health promotion campaigns) or concierge-type services designed to help manage life issues (e.g., care for a child or pet)
(e) It alleviates facility and staff investment, infrastructure and administrative responsibilities for the plan sponsor organization.
Explain how EAP claims administration differs from extended health care and dental claims administration.
Unlike health benefits paid under extended health care or dental plans, plan members do not submit claims to an insurer or plan administrator for reimbursement. The EAP provider is paid directly by the plan sponsor.
Provide examples of types of information regarding EAP services that can and cannot be released to plan sponsors.
For self-referrals or guided referrals, no one other than the EAP professionals who assist the covered individual should be aware that that individual accessed the EAP or for what issue. Privacy laws protect what is discussed during the sessions, any information about an individual’s progress in treatment is protected and this information can be released only with that plan member’s written permission.
A mandatory referral may or may not appear in the individual’s personnel file depending on the situation. Often, there is no notation unless there is a need for formal disciplinary action. In some cases, the plan member signs a release of information so the EAP provider can provide information to the employer about member attendance, compliance and recommendations. What is discussed during the sessions, however, is not reported to the employer.
Provided the group is not too small and the release of statistical information would not identify individual participant utilization, the plan sponsor can receive aggregate data and statistics such as the age of plan users, the types of services used, the frequency of usage, the number of cases resolved and the types of issues for which covered individuals sought assistance. These types of reports are useful for assessing the value of an EAP to the plan sponsor and the performance of the provider as well as for identifying utilization trends that can inform plan design and funding.
Contrast the fixed and reconcilable arrangements for funding EAPs.
A fixed funding arrangement is similar to an insured nonrefund accounting arrangement. The plan sponsor pays a fixed rate and, if utilization is above/below expected, there is no payment owing or refunded. However, at renewal, the actual utilization may be taken into consideration, and this could result in a higher or lower rate for the next plan year.
A reconcilable funding arrangement is similar to an insured refund accounting arrangement. The plan sponsor pays a predetermined rate during the year and, at the end of the year, the EAP provider does a reconciliation to determine whether there is any payment owing or amount credited. If actual plan utilization is above the expected utilization rate, the plan sponsor owes a payment to the EAP provider. If actual utilization is below the expected utilization rate, the EAP provider may provide a credit to the plan sponsor. There are a number of variations on this type of arrangement. Some contracts allow only for reconciliations upward to determine payment owing but do not provide credits. There can also be a cap on the maximum utilization for which a payment would be owing. For example, if the budgeted/target utilization is 7% and the contract is reconcilable up to a 10% cap, even if actual utilization is 12%, the reconciliation would only calculate a payment owing up to 10%. If the contract allows for credits, there can also be a reconciliation floor
(e.g., 5%).
Explain how group size impacts the funding decision for EAPs.
Fixed funding arrangements are more common for smaller groups, but they are also used for larger groups, so there isn’t a clear differentiation in terms of funding arrangement based on group size. Both fixed and reconcilable arrangements are common for large groups with 500+ lives.
