WELLNESS PROGRAMS
Wellness Programs
A Look At New EEOC Rules
In an effort to reduce health care costs , many employers offer wellness programs that seek to improve employee health and well-being by creating and maintaining healthy lifestyles as well as by promoting behaviors that prevent disease . Designing an effective wellness program can be complex , but Bowen , Miclette & Britt has all the necessary resources to help you create a program that suits your employees ’ needs while also meeting your financial goals .
Wellness programs exist in many forms such as nutrition classes , health risk assessments , on-site exercise facilities and smoking cessation programs , just to name a few . They may also include health screenings that measure an employee ’ s health risk factors such as cholesterol , BMI , glucose and blood pressure . Many employers offer incentives to their employees based on participation in the wellness program ( participatory wellness programs ) or based on the employee meeting certain health outcomes ( health-contingent wellness programs ).
For these programs to be offered , the Americans with Disabilities Act ( ADA ) requires that they be “ voluntary ” programs . The ADA defines a voluntary wellness program as one whose incentives are 30 percent or less than the cost of employee-only coverage .
Previously , wellness programs were primarily regulated by the Health Insurance Portability and Accountability Act ( HIPAA ) nondiscrimination rules for wellness programs and the Affordable Care Act , with guidance from the ADA but with no definitive rules . On May 16 , 2016 , the Equal Employment Opportunity Commission ( EEOC ) released final rules applicable to employer-sponsored wellness programs . The new rules and guidance fall under Title I of the ADA , which permits collection of medical information under an employer ’ s voluntary wellness program . Additionally , the EEOC published final regulations on wellness program participation by employees ’ spouses under Title II of the Genetic Information Nondiscrimination Act ( GINA ).
WHEN ARE THE NEW EEOC RULES EFFECTIVE ?
• For plan years beginning on or after January 1 , 2017 .
WHO MUST COMPLY WITH THE NEW EEOC RULES ?
• Wellness programs that include disabilityrelated inquiries or medical examinations .
• Employers with fifteen or more employees ( rules apply to all employees , not just those that are covered by an employersponsored medical plan ).
HOW DO THE ADA FINAL RULES IMPACT WELLNESS PROGRAMS ?
• Incentive maximums now apply to both participatory and health-contingent wellness programs .
• The 30 percent incentive maximum calculation is dependent upon whether employees who are not covered by the employer-sponsored medical plan are allowed to participate in the wellness program . There are four possible situations :
• If the wellness program is only offered to employees enrolled in the company medical plan , the incentive maximum may not exceed 30 percent of the cost of the employee-only coverage for which the employee is actually enrolled .
• If the wellness program includes employees who are not enrolled in the company medical plan and the employer only offers one medical plan , then the 30 percent maximum is based on the total cost of employee-only coverage .
• If the wellness program includes employees who are not enrolled in the company medical plan and the employer offers more than one medical plan option , then the 30 percent cap is based on the total cost of employee-only coverage for the lowest cost medical plan .
• If the employer does not offer an employer-sponsored medical plan , the 30 percent incentive maximum is based on the premium amount for a 40-yearold nonsmoker who purchases self-only coverage under the second lowest cost Silver Plan through the health insurance exchange where the employer has its headquarters
• If an employer offers tobacco cessation
BY : IMOGEN GANTOS , HEALTH AND PRODUCTIVITY DIRECTOR , BOWEN , MICLETTE & BRITT INSURANCE AGENCY , LLC
incentives and conducts tests for the presence of nicotine or tobacco , the incentive maximum is 30 percent . But if an employer does not do testing and only asks the employee if they use tobacco products , then the incentive maximum may be increased to 50 percent .
• All incentives count toward the incentive maximum . This may even include incentives provided by the health plan , like a $ 50 gift card for completing a health risk assessment ( HRA ) or telephonic coaching .
• Employers are not allowed to use wellness programs to preclude an employee from enrolling in certain health plans .
• A new notice is required which describes what information will be collected as part of the wellness program , who will receive it , how it will be used , and how it will be kept confidential .
• An employer may only receive aggregate data from the wellness program .
• The voluntary plan safe harbor does not apply to wellness programs .
HOW DO THE GINA FINAL RULES IMPACT WELLNESS PROGRAMS ?
• Employers must obtain a voluntary written authorization from the spouse if the employer offers an incentive to the employee for his or her spouse to complete an HRA or biometric screening .
• The value of the maximum incentive attributable to a spouse ’ s participation may not exceed 30 percent of the total cost of self-only coverage , which is the same incentive allowed for the employee .
• No incentives are allowed in exchange for the current or past health status information of an employee ’ s child or in exchange for the specified genetic information ( such as family medical history or the results of genetic tests ) of an employee , an employee ’ s spouse , or an employee ’ s child . +
Imogen Gantos is the Health and Productivity Director at Bowen , Miclette & Britt , an insurance agency based in Houston , Texas .
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