NEWSROOM

If you have been selling employee benefits in California, you are probably familiar with state’s Knox-Keene Health Care Service Plan Act, which regulates health care service plans and managed care organizations like HMOs.

Most standalone Employee Assistance Programs (EAP) vendors are not considered health plans and are not subject to the Knox-Keene license rules. They are typically treated as wellness or ancillary services. 

If, however, an EAP offers four or more clinical treatment sessions, the state of California can view that EAP as practicing health care without a license, unless the vendor is working through a licensed Knox-Keene plan. 

Because many EAP vendors are not licensed, they have to limit the number of counseling sessions provided to California members. Some EAPs cap sessions to “three every six months,” as a compliance workaround, and to keep services in the “assessment, referral, crisis help” category and not ongoing treatment. 

Carrier EAPs

Carriers all set up their EAP arrangements differently and do not always communicate session limits unless someone asks or a compliance issue pops up. Since the EAP is carved in (but run separately), carriers often rely on the vendor to manage the details.

If a carrier includes an EAP but the actual vendor is not Knox-Keene licensed, California members might be limited to fewer sessions and less frequent visits. 

This differentiation is getting more attention in California right now because of the increased focus on mental health licensing and federal parity enforcement.

W&B’s EAP Partnership

W&B has a long-standing partnership with The Holman Group, a Knox-Keene licensed EAP plan, so you can offer unrestricted standalone EAP benefits. We reached out to The Holman Group to see how they handle this and Elizabeth Holman, president, shared this information:

“We have a full Knox-Keene license and can offer all session models for outpatient mental health counseling including EAP. Also, we have clients who carve mental health out of their medical plans or provide wrap-around mental health coverage to supplement other employee benefits.”

If you have questions on EAP or Knox-Keene licensed plans, please contact your W&B rep for more information.