Wellness Incentives

The Affordable Care Act (ACA) creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. Currently, employers can offer up to 20% of the cost of the health plan coverage as an incentive to achieve certain wellness goals.  In 2014, the 20% cap is increased to 30%.  There will also be an additional 20% that can be added to the cap to reward success with tobacco cessation programs.  Thus, up to 50% of the cost of the health plan coverage will be available as an incentive to stop smoking.

Protecting Consumers

In order to protect consumers from unfair practices, the proposed regulations would require health-contingent wellness programs to follow certain rules, including:

      • Programs must be reasonably designed to promote health or prevent disease. To be considered reasonably designed to promote health or prevent disease, a program would have to offer a different, reasonable means of qualifying for the reward to any individual who does not meet the standard based on the measurement, test or screening.  Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.
      • Programs must be reasonably designed to be available to all similarly situated individuals.  Reasonable alternative means of qualifying for the reward would have to be offered to individuals whose medical conditions make it  unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard.
      • Individuals must be given notice of the opportunity to qualify for the same reward through other means.

These proposed rules provide new sample language intended to be simpler for individuals to understand and to increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan or issuer to request it.

Federal Grants to Small Businesses for Comprehensive Wellness Programs

To encourage small businesses to set up wellness programs, $200 million in grant money is being made available by the Federal Government.  According to the Department of Health and Human Services website, this program is still under development and not expected to be released until 2014.

The businesses must:

      • Have no more than 100 employees who work 25 hours or more per week.
      • Not have a wellness program.
      • Use the grant for a comprehensive wellness program.

A comprehensive program is one that:

      • Helps participants learn more about their health and how to stay healthy.
      • Encourages employees to participate.
      • Helps participants change their behavior through counseling, seminars, online programs and helpful materials.
      • Encourages participants to eat healthy, get more exercise and improve their mental health.
Glocal Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Clients are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the clients’ business activities.