Certain employee assistance programs (EAPs) are excepted benefits

Health Care Reform bulletin

Under final regulations, applicable for plan years beginning on or after January 1, 2015, an EAP will constitute excepted benefits if the following four requirements are met:

1. The EAP does not provide significant benefits in the nature of medical care. For this purpose, the amount, scope and duration of covered services are taken into account.

2. The EAP’s benefits are not coordinated with benefits under another group health plan. This requirement has two elements:

  • Participants in the other group health plan must not be required to use and exhaust benefits under the EAP (making the EAP a “gatekeeper”) before they are eligible for benefits under the other group health plan; and
  • Eligibility for benefits under the EAP must not be dependent on participation in another group plan

3. No employee premiums or contributions are required to participate in the EAP.

4. The EAP does not impose any cost-sharing requirements.

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