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HHRC-EOC 02.10.2017 1 Evidence of Coverage <br />HEALTH AND HUMAN RESOURCE CENTER <br />(dba AETNA RESOURCES FOR LIVING) <br />10260 Meanley Drive <br />San Diego, CA 92131 <br />1-800-342-8111 <br />EMPLOYEE ASSISTANCE PROGRAM <br />COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM <br />The Employee Assistance Program (EAP) is being offered by your employer to provide you with <br />confidential assistance from licensed mental health professionals. These professionals can help <br />with problems affecting your life at work as well as at home. Such problems include marital issues, <br />family relationships, depression and anxiety, alcohol and drug issues, and/or problems within the <br />workplace. <br />The EAP counselors will conduct a thorough assessment of your problem and together with you <br />will decide on an action plan that will either resolve the issue within the EAP sessions or will refer <br />you to appropriate providers and/or community resources that have been reviewed by the EAP. <br />Your involvement with the EAP counselor will be at no cost to you. <br />This Combined Evidence of Coverage and Disclosure Form constitutes only a summary of <br />the health plan. The EAP Services Agreement must be consulted to determine the exact terms <br />and conditions of coverage. A copy of the agreement will be furnished on request and is <br />available from your employer. <br />This Combined Evidence of Coverage and Disclosure Form discloses the terms and conditions of <br />coverage. It also provides you with important information on how to obtain Benefits and the <br />circumstances under which Benefits will be provided to you. PLEASE READ IT CAREFULLY. <br />Individuals with special health care needs should read carefully those sections that apply to them. <br />Keep this publication in a safe place where you can easily refer to it when you are in need of <br />Benefits. <br />Contact Plan at 1-800-342-8111 to receive additional information about Benefits. <br />Enclosed as Exhibit B is Plan’s matrix of covered services. <br />EAP Plans - IMPORTANT: Can you read this document? If not, we can have somebody help you <br />read it. You may also be able to get this document written in your language. For free help, please <br />call right away at 1-877-287-0117. <br />Planes EAP - IMPORTANTE: ¿Puede leer esta documento? En caso de no poder leerla, le <br />brindamos nuestra ayuda. También puede obtener esta documento escrita en su idioma. Para <br />obtener ayuda gratuita, por favor llame de inmediato al 1-877-287-0117. <br />REV: 03-10-23 MI <br />ATTY/AGR.2023.039/Aetna (EAP Services Agreement) (Page 25 of 42)