WASHINGTON – The U.S.
Department of Health and Human Services issued final rules on employment-based
wellness programs. The final regulations 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; that provide a reward
to employees for attending a monthly, no-cost health education seminar; or that
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, or
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.
The 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.
The final rules will be
effective for plan years beginning on or after Jan. 1, 2014.