Final Rule Issued on Insurance Coverage of Wellness Programs
June 12, 2013 08:34 AM
The U.S. Departments of Health and Human Services, Labor, and the Treasury issued a final rule on May 29on employment-based health-contingent wellness programs. The final rule can be found here.
A “health-contingent wellness program is a program that requires an individual to satisfy a standard related to a health factor to obtain a reward or requires an individual to undertake more than a similarly situated individual based on a health factor in order to obtain the same reward.”
The rule applies to group health plans and health insurance issuers. The intent of the rule is to promote health and prevention through insurance coverage and to prevent discriminatory practices by insurers in accord with the Affordable Care Act. It supports “participatory wellness programs” such as membership fees in a fitness center, rewards to employees for attending a monthly, no-cost health education seminar, or rewards to employees who complete a health risk assessment. Individuals must be given the opportunity to participate at least once a year. Plans are required to offer reasonable alternative standards for persons for whom it is medically inadvisable to participate.
The rule promotes flexibility and establishes standards for nondiscriminatory wellness programs. Examples include programs targeted to decrease of tobacco use and weight and cholesterol control programs that reward not only individuals who achieve established goals but also individuals who take healthy actions.
The final rule also increases the maximum reward allowable under health-contingent wellness programs from 20 percent to 30 percent of the cost of coverage to 50 percent.
The final rules will be effective for plan years beginning on or after January 1, 2014.