EAP Exclusions: What Services Are Not Covered?

If you are contracted with CIGNA Behavioral Health (CBH) to provide EAP services to our plan members, you are probably aware of our face-to-face counseling and work/life programs designed to assist members with a variety of issues. From time to time, we receive calls from practitioners asking about providing services beyond the scope of the EAP benefits to members. Listed below are services that are excluded from the EAP. This list can also be found in the Provider Guide located on the CBH website at www.cignabehavioral.com.

 

The CBH EAP benefit excludes coverage for:
· Psychiatric Evaluations
· Psychological Testing
· Court Ordered Treatment
· Workman’s Compensation/Disability Management
· Medication Management
· Fitness for duty/Return to Work determination
· Employment Law
Special Note: Coverage for Employment Law is excluded due to the dual nature of the EAP client—the individual employee (family member) and the employer who sponsors the program. Any legal advice given by a provider to an individual client concerning employment law can have potentially detrimental consequences for the employer client. To avoid this conflict of interest, Employment Law services are excluded from the program. In the course of delivering EAP services, practitioners shall refrain from discussing legal recourse as a potential action in resolving workplace concerns or disputes. Further examples of excluded employment law questions/concerns can be found in the Provider Guide.

   

Management/Mandatory Referral Communication Reminder

If you evaluate an EAP member referred by their employer for job performance problems, reporting concise information to the Employee Assistance Consultant (EAC) regarding your clinical assessment, dates of attendance, follow-up plans, referral recommendations, and compliance information is very important. Please work with the EAC to establish reporting timelines as well as methods of communication i.e., fax, telephonic, email. Occasionally, an EAP client may request that you contact their employer. Please do not speak with the employee’s workplace representative. Inform the client that you will be updating the EAC who will then report compliance information to the workplace.

   

Employee Assistance Professionals Association 2007 World Conference

Practitioners frequently ask us about EAP training events and we want let you know about this premiere EAP conference that will be held October 25-27, 2007 in San Diego, CA. Multiple EAP topics will be presented. For more details, click on the link to EAPA website http://www.eapassn.org/public/pages/index.cfm?pageid=1".

   

Your Ideas Welcome

If you have topics you'd like to see addressed please let us know. Contact us at ProviderEducationSpecialist@cignabehavioral.com and we'll dig into it. We want this brief to be as informative and insightful as possible and to address topics important to our practitioner community.

   

Now Available on our Website

Have you missed any of our monthly eBriefs? As of February our monthly eBriefs are now available on our website at www.cignabehavioral.com for you to reference. Note: if you are having difficulty connecting via the link provided, highlight the link, copy, and paste into your browser.