FAST FACTS
- Eligible employees and family members are eligible for up to eight free sessions per incident with a qualified counselor from the EAP.
- The counseling and/or referrals provided by the EAP are conducted on a strictly confidential basis and at no cost to you.
- The EAP has a free Benefit Navigation Program for any mental health or substance abuse treatment you or an eligible dependent may need.
- Mental health and substance abuse benefits are not available to H Plan participants, but H Plan participants may use the EAP to seek assistance with mental health and substance use disorder.
Mental Health and Substance Use Disorder Benefits
- Outpatient treatment is payable at 80% of the allowance after you’ve satisfied your annual deductible.
- Inpatient treatment is payable at 100% of the allowance up to the first $7,000. After the first $7,000, you’ll be reimbursed for expenses at 80% of the allowance for each spell of illness.
- Charges for mental health and substance use disorder are expenses included in the calculation of Lifetime Benefits and Annual Limits.
- Mental health and substance use disorder benefits are not available to H Plan participants, but H Plan participants may use the EAP to seek assistance with mental health and substance use disorder.
Note: This benefit provided for both Standard Plan (full) and “H” Plan (limited) coverage.
The Mental Health/Employee Assistance Program (EAP) is a free, confidential program that provides counseling services for you and your family. The Employee Assistance Program (EAP), provided through Business Health Services, has counselors available 24 hours a day, seven days a week to help you deal with job stress, depression, marital, family or financial problems. Use the Employee Assistance Program (EAP) to navigate through the process of finding an appropriate mental health professional if your issue cannot be treated within the eight free sessions. Contact the Employee Assistance Program (EAP) by calling 1-888-784-5665.
How the Employee Assistance Program (EAP) Works
If you are having trouble dealing with job stress, financial issues, depression or family problems, contact the Employee Assistance Program (EAP) by calling 1-888-784-5665. A counselor will speak with you and set up an appointment, if necessary. You may meet with your counselor for up to eight free counseling sessions. Also, the counselors at Business Health Services (BHS) can refer you to a qualified, low- cost, or no-cost provider or program through the UHC network to meet your needs. See Schedule of Benefits for information about your Mental Health benefits.
If your level of care or the name of the person/provider changes, you should contact the Employee Assistance Program (EAP) for free access to the Benefit Navigation Program.
Mental Health and Substance Use Disorder Benefits
Note: This benefit is provided for Standard Plan (full) coverage only; no provision for “H” Plan (limited) coverage.
You and your family members are eligible to receive inpatient or outpatient care for the treatment of mental health and substance use disorder. The Plan will pay for covered expenses, including hospitalization and psychological testing, if clinically appropriate.
Benefit navigation with the EAP for any mental health or substance use disorder treatment is available. Contact the EAP by calling 1-888-784-5665.
ABA Therapy
Applied Behavior Analysis (ABA) Therapy for the treatment of autism is covered under the Plan when performed by a licensed provider.
What You Need To Do
You should contact the EAP at 1-888-784-5665 for benefit navigation before beginning any course of mental health or substance use disorder treatment. Next, set up an appointment to meet with an EAP counselor for an assessment and, if appropriate, a referral. If you are referred to a provider for treatment, be sure to show your EWTF ID card to receive the Plan discounts.
Outpatient Benefits
Benefits for outpatient treatment for mental health and substance use disorder are paid at 80% of the allowance once the annual deductible has been met. Outpatient services may be rendered by a duly licensed and certified provider.
Inpatient Benefits
The first $7,000 of eligible expenses for room and board and other covered inpatient services are paid in full. Charges you incur that exceed $7,000 are paid at 80% of the allowance.
Psychological Testing
Benefits are payable at 80% of the allowance subject to the annual deductible. When psychological testing has been ordered to determine if the patient has Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD), contact BHS for benefit navigation and referral to a provider of service.
Filing Claim
If you use a participating provider, your claims should be mailed to:
UMR
PO Box 30541
Salt Lake City, UT 84130-0541
EWTF Group Number
The group number for EWTF is 76-416098. The group number should be given to each provider and included on each claim submitted.
What’s Not Covered
The Plan does not provide benefits for marriage counseling (except through the EAP benefit). However, this exclusion does not limit a Participant’s or dependent’s eligibility for any mental health benefit otherwise covered under this Plan.
Please see Specific Plan / Benefits Exclusions and General Plan Exclusions for more information.