The U.S. Departments of Health and Human Services, Labor and the Treasury continued to move forward to implement the health care law. On May 29, 2013, final rules on employment-based wellness programs were released, effective for plan years beginning on or after Jan. 1, 2014.
The final rules support workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and limit growth of health care costs, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.
The final rules continue to support “participatory wellness programs,” which generally are available without regard to an individual’s health status. These include programs that:
- reimburse for the cost of membership in a fitness center
- provide a reward to employees for attending a monthly, no-cost health education seminar
- reward employees who complete a health risk assessment, without requiring them to take further action
The rules also outline standards for nondiscriminatory “health-contingent wellness programs,” which generally reward individuals who meet a specific standard related to their health. Examples of health-contingent wellness programs include:
- programs that provide a reward to those who do not use, or decrease their use of, tobacco
- programs that reward those who achieve a specified health-related goal such as a specified cholesterol level, weight, or body mass index, as well as those who fail to meet such goals but take certain other healthy actions
These final rules ensure flexibility for employers by increasing the maximum reward that may be offered under appropriately designed wellness programs, including outcome-based programs. The final rules also protect consumers by requiring that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness.
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