Wellness Programs Under Health Care Reform

Many employers are implementing wellness programs for their employees as health care reform has made wellness programs more desirable.

Health care reform encourages participatory wellness programs that do not depend on an employee’s health status. These programs include, for example, reimbursement of the cost of gym memberships, rewards for attending health education seminars, or completion of health risk assessments that do not require specific action.

Health care reform addresses health-contingent wellness programs which require employees to meet a specific standard relating to their health in order to receive a reward. These programs include, for example, rewards for not using or decreasing tobacco use, rewards for reaching a certain cholesterol level, or rewards for losing weight.

The incentive under a health-contingent wellness program is limited by the Affordable Care Act and HIPAA. Health care reform has increased the maximum incentive amount under a health-contingent wellness program to up to 30% of the cost of coverage. The reward may be as much as 50% of the cost of coverage if the program is designed to prevent or reduce tobacco use.

An acceptable health-contingent wellness program must meet certain criteria. Specifically, the program

  • Must be designed to promote health or prevent disease. It must offer a different, reasonable means of qualifying for the reward to anyone who does not meet the standard based on the measurement or test. The program must not be overly burdensome.
  • Must be designed to be available to all similarly situated individuals. If it is unreasonably difficult or medically inadvisable for a person to meet the standard, an alternative must be available.
  • Must provide notice of the opportunity to qualify for the reward through an alternative means. Health care reform offers certain language that must be included in the notice.

Wellness programs are intended to encourage healthy behavior to decrease long-term health care expenditures for employers. Employers may wish to consider such programs, especially as they can now provide greater financial benefits under health care reform.

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