EFAP vs Extended Health Benefits: How to Use Both for Counselling

Introduction

If you’ve ever been told by HR that you have “an EAP” or “EFAP” and also a benefits package with mental health coverage, and you weren’t sure whether those were the same thing or different things or whether you were supposed to use one before the other, you’re in the company of most of your coworkers. The two systems coexist in most workplace benefits packages, they’re often administered by completely separate vendors, and they’re rarely explained together.

The short version: they’re not the same but they can be complementary. Used in sequence, they often give you more access to therapeutic care than either one alone, and members of plans that include both routinely use only one because nobody walked them through how the two fit together.

This post is for folx who want to understand the difference, use both, and get the depth of therapeutic work they actually need without burning through one bucket and stopping. We’ll cover what each is, when to use which, the privacy distinctions that matter, and how continuity of therapist can sometimes carry across the seam between them.

Two systems, one confusion

The reason this gets confusing is that EFAP and extended health benefits do similar-sounding things (both can fund counselling) through entirely different mechanisms. They were also designed for different purposes, and the labour relations history matters.

EFAPs (Employee and Family Assistance Programs, sometimes called EAPs without the “Family”) emerged in the 1970s and 1980s as a way for employers to provide brief, confidential intervention for issues that were affecting work performance. They’re typically administered by a contracted third-party vendor, and the model was built around short-term solution-focused work: three to eight sessions, then a referral elsewhere if more was needed.

Extended health benefits, by contrast, are a piece of your overall compensation package, structured as insurance and intended to fund a wider range of healthcare services including ongoing therapeutic work. They’re the same bucket of money your dental cleanings and physio appointments come from. The annual maximum for mental health under extended health is what determines how much ongoing therapy you can do; the per-session cap and reimbursement rate determine the per-visit math.

Two systems, layered on top of each other, both legitimately yours, almost never explained together. The result: most members of plans that include both use only one. They use up the EFAP sessions, the contract therapist says “we’ve reached our limit, here are some referrals,” and the member assumes the journey is over, when their extended health benefits have been sitting there the whole time.

What EFAP actually is

EFAP is a short-term, employer-paid counselling program delivered through a contracted vendor. The mechanics:

• Number of sessions. Typically 3 to 8 free sessions per “issue” or per year, depending on the program. Some programs structure it as a number of sessions per concern (a rolling 8 sessions for relationship issues, another rolling 8 for workplace stress, etc.); others as an annual cap
• Cost to you. $0 at point of use. Your employer pays a flat per-employee fee to the EFAP provider regardless of usage; you using the program doesn’t cost your employer extra and doesn’t draw from your extended health
• Therapist selection. Limited. EFAP providers maintain a network of contract therapists, and you’re typically matched to someone in that network. EFAP providers pay your counsellor less than average session rates, so you typically have less access to range of providers. That being said, you can sometimes request a specific identity-fit (a therapist of colour, an LGBTQ2S+-affirming therapist, etc.), but availability varies
• Format. Often virtual or phone-based, sometimes in-person depending on the program and your location.
• What it’s good for. Crisis support, brief workplace-related intervention, navigating a specific situation (a divorce, a death, a relocation), getting unstuck from an acute problem
• What it’s less good for. Long-term therapeutic work, complex trauma, attachment work, identity-deep relational therapy, or anything where the relationship with a specific therapist over time is part of how the work happens

The brevity is by design. EFAP was structured for triage, not depth. For some concerns, six sessions of focused, solution-oriented work is exactly the right intervention. For other concerns, six sessions is the door to the room you actually need to be in.

The most important thing to note about EFAP usage is that most third-party providers require your counsellor to submit notes for each session in order for them to get paid. This gives the third-party provider access to your notes which can be a concern, privacy-wise. They also typically require in-depth assessments in order to access services. Counsellors at Venturous who work with third-party providers always submit very general notes to add an additional layer of privacy, but not all counsellors work the same way. For more information on the notes and assessments that get submitted by your counsellor, its best to reach out directly to them.

What extended health benefits cover

Extended health benefits are the per-year mental health coverage layered into your benefits package. The mechanics:

• Annual maximum. Typically $500 to $3,000 per year, depending on plan. Many union and public sector plans have supplemental funds layered on top (we cover those in our post on counselling benefits for BC teachers, nurses, and public sector workers)
• Per-session reimbursement. Usually 70% to 100% of the session fee, up to a per-visit cap (commonly $90 to $150 per session)
• Cost to you. Either $0 (if your plan covers 100% up to the cap and the practice direct bills) or a partial amount (if the plan covers a percentage). With direct billing for counselling in Vancouver, you pay only the difference
• Therapist selection. Yours. You choose your own counsellor; coverage is based on the practitioner’s credentials, not on whether they’re in a specific network. Choosing your own counsellor under BC benefit plans walks through this in detail
• Format. Whatever format you and your therapist agree on. Most plans cover virtual and in-person sessions equivalently
• What it’s good for. Ongoing therapeutic work, depth, working with a specific therapist over time, complex trauma, attachment-based work, identity work, somatic and relational approaches, anything where the relationship is part of the work

The Canadian Psychological Association recommends $3,500 to $4,000 per year as the threshold for adequate, evidence-based treatment. Most extended health plans sit below that, which is part of why the supplemental funds matter and why combining EFAP with extended health stretches your access further.

Counselling with extended health benefits do not require your counsellor to submit notes or do a comprehensive assessment in order for the coverage to work. If you’re concerned about privacy, this is a significant distinction.

Why using both makes sense

Here’s the strategic part. EFAP sessions don’t draw from your extended health limit. They’re funded separately, paid for through a separate contract, and counted against a separate cap. That means using both, in sequence or in combination, gives you significantly more access than using either one alone.

A practical example. Imagine you’re navigating a difficult work situation that’s started to affect your sleep, your focus, and your relationships. You have access to EFAP (3-8 sessions per year) and extended health benefits through Pacific Blue Cross ($1,500 per year for mental health). The most effective use of both might look like:

• First 3 to 8 sessions through EFAP, working on the immediate situation: sleep, work boundaries, the specific stressors. Free at point of use, no impact on your extended health limit
• Continuation through extended health, with a therapist of your choice (potentially the same EFAP therapist if they’re eligible under your extended health plan, or a new therapist who fits the deeper work you want to do), accessing $1,500 of ongoing therapy

If therapist fit is your most important concern, which makes sense seeing as therapist fit accounts for more than half of therapy’s effectiveness, a better path might look like starting with your extended health benefits and then using your EFAP benefits that your counsellor also qualifies for. This may require your counsellor to sign up with a particular EFAP, having your EFAP vendor add your counsellor, or coordinating with your counsellor to see if they are already affiliated with your EFAP provider.

In that combined model, you’ve gotten roughly 14 to 18 sessions of work over the course of the year, depending on session fees, without paying out of pocket beyond what your benefits already cover. If you’d used only EFAP, you’d have stopped at 3 to 8 sessions.

The continuity question: same therapist across both?

The most common question we get from folx who’ve started with EFAP and want to continue with extended health: can I keep the same therapist?

Sometimes. It depends on three factors:

1. Whether your EFAP therapist is registered in a way your extended health plan covers. If your EFAP therapist is a Registered Clinical Counsellor (RCC) and your extended health plan covers RCCs, the same therapist can often see you under extended health after the EFAP sessions are used. If they’re a different credential type (an RTC or CCC, an unregistered counsellor, etc.) that your extended health doesn’t cover, the continuity isn’t possible.

2. Whether your EFAP therapist accepts extended health clients. Many EFAP-network therapists also have private practices that accept extended health billing. Some don’t. The simplest way to find out is to ask in your first or second EFAP session: “If we’re still working together when my EFAP sessions run out, do you also see clients through extended health?” Most therapists will tell you directly. It might also be worthwhile to ask if they offer direct billing, which can significantly reduce the amount of admin time and wait time for reimbursement that helps make accessing therapy easier.

3. Whether your EFAP provider’s contract allows the transition. Some EFAP contracts include a non-compete or a referral-out clause. Most don’t, but some do. The EFAP therapist will typically know.

If continuity isn’t possible, the next best path is choosing your extended health therapist with the EFAP work in mind. Find someone whose approach extends what worked in EFAP into the deeper work you want to do. Many practices, including Venturous Counselling, will start with a free 15-minute consultation specifically so you can ask about how the new therapist would build on what you’ve already started.

Privacy: who sees what

Both EFAP and extended health benefits protect your privacy, but the specifics differ.

EFAP privacy. EFAP sessions are confidential between you and the EFAP therapist. Your employer does not see who is using the program, what they’re using it for, or what’s discussed. The EFAP provider may share aggregated, anonymized usage data with your employer (e.g., “23% of employees used the program this year,” “the most common reason for use was workplace stress”), but no individual data. Some EFAP programs have additional rules about when records would be released (workplace return-to-work plans, fitness-for-duty assessments tied to disability claims), and those should be explained to you at intake. That being said, your privacy is now up to your EFAP provider and is out of your counsellor’s hands for the most part.

Extended health privacy. Your extended health insurer processes your claim and sees the practitioner’s name, the service code, and the cost. They do not receive your therapist’s notes or the content of your sessions unless you sign a specific release. Your employer pays into the plan but does not see individual claims data.

If you’re concerned about something specific (a security clearance, a custody process, a future life or disability insurance application), it’s worth asking your therapist directly before starting either pathway. Our explainer on direct billing for counselling covers this in more depth.

How to find out what you have

The fastest path to clarity is two short steps:

1. Check your EFAP. Look for “Employee and Family Assistance Program” or “EAP” on your employer’s HR portal, in your benefits booklet, or in any onboarding materials. The EFAP provider name tells you who to call. The number of sessions, the access method (phone, app, web portal), and any specific rules will be listed.

2. Check your extended health. Log in to your extended health insurer’s member portal (Pacific Blue Cross, Manulife, Sun Life, Canada Life, GreenShield, etc.) and look at your Coverage Details for mental health practitioner coverage. The annual maximum, per-visit cap, and percentage covered are the key numbers.

Once you have both, the strategic question becomes obvious: which order, for which work, with which therapist. We help folx think through this regularly, including in free 15-minute consultations before any session is booked.

Frequently asked questions

What’s the difference between EFAP and extended health benefits for counselling?

EFAP is a short-term, employer-paid program through a contracted vendor (commonly TELUS Health, Homewood, or Inkblot) offering 3 to 8 free counselling sessions per concern, with the therapist drawn from the EFAP provider’s network. Extended health benefits are a per-year dollar amount in your benefits package that you use with a counsellor of your choice, with reimbursement of 70% to 100% of session fees up to a per-session cap. EFAP is for short-term intervention; extended health is for ongoing therapeutic work.

Can I use both EFAP and extended health benefits in the same year?

Yes. EFAP sessions don’t draw from your extended health limit; the two are funded separately. Many people use EFAP first for short-term work, then continue with a counsellor of their choice through extended health. Combining the two can effectively double your access to counselling without doubling your effort.

Will my employer find out I used my EFAP?

No. EFAP sessions are confidential between you and the EFAP therapist, for the most part. Your employer pays the EFAP provider a flat fee regardless of usage and generally doesn’t receive individual data about who used the program or what they discussed. The provider may share aggregated, anonymized usage statistics with your employer, but usually no individual information. That being said, privacy policies may change and will be out of your counsellor’s hands so it’s best to confirm with your EFAP provider.

Are EFAP sessions long enough to actually work through something?

For brief, focused, solution-oriented concerns, yes. For complex trauma, attachment-based work, identity work, or anything that depends on a long-term relationship with a specific therapist, EFAP’s structure (3 to 8 sessions) usually isn’t enough. Combining EFAP with extended health is how most folx access the depth of work they actually need.

Can I keep the same therapist when I move from EFAP to extended health?

Sometimes. Continuity depends on whether your EFAP therapist is registered in a way your extended health plan covers (commonly RCC, RSW, or psychologist), whether they accept extended health clients in their private practice, and whether the EFAP contract allows the transition. The simplest way to find out is to ask your EFAP therapist directly in an early session.

What happens if I use my EFAP sessions and still need more support?

If your therapist is eligible under your extended health plan and accepts extended health clients, you can often continue with the same therapist. If not, you can transition to a new therapist who works through extended health, ideally with a free consultation first to talk through how they’d build on the EFAP work. Choosing your own counsellor under BC benefit plans covers this in more depth.

Do EFAP sessions count toward my extended health annual maximum?

No. EFAP and extended health are separately funded. EFAP sessions are paid for by your employer through a flat per-employee contract with the EFAP provider; they don’t draw from your extended health pool.

Is the therapist quality different in EFAP versus extended health?

Therapists in EFAP networks are licensed, regulated practitioners (typically RCCs, RSWs, or psychologists) who have signed contracts with the EFAP provider. Therapists you see through extended health are also licensed, regulated practitioners. The quality of therapeutic care depends on the individual therapist, not on the funding pathway. Where EFAP can fall short isn’t necessarily quality but fit and depth: you have less choice in who you’re matched with, and the format is structured for short-term work.

How do I find out if my workplace has an EFAP?

Look in your HR portal, employee benefits booklet, or onboarding materials for “Employee and Family Assistance Program” or “EAP.” Your HR or People & Culture team can confirm in a quick email. You don’t have to explain why you’re asking.

Can family members use my EFAP?

In most EFAPs, yes. The “F” in “EFAP” usually means the program covers your spouse or partner and dependent children up to a certain age. The number of sessions per family member varies by program. Check your specific program’s rules.

Next steps

If you’re trying to figure out how to use both EFAP and extended health benefits effectively, we can help you think through it before you book anything.

You can book a free 15-minute consultation to talk through the sequencing, fit, and any benefits questions. You can also take our 3-minute matching quiz if you want a counsellor recommendation based on what you’re navigating right now. Our direct billing page has the full live list of insurers we work with for the extended health side.

If you want to dig deeper into the broader benefits picture, our complete guide to extended health benefits for counselling in BC walks through the full landscape, including supplemental funds and union-specific coverage.

Work with a Venturous Counsellor

Julianna Lei (MCP, RCC) brings an inquisitive and relational tone to therapy that’s particularly well-suited for folx new to the process or returning after a long break. She works with youth and adults individually and through relationship counselling. She also offers nature-based therapy in Vancouver and Burnaby alongside her in-office and online practice. If you’ve been hesitant about therapy because you’ve felt rushed, judged, or oversimplified by past experiences, Julianna’s pace and care show up in the first session.