New Affordable Care Act Regulations on Wellness Programs
On November 20, 2012 the U.S. Department of Health and Human Services (HHS) released new rules regarding the implementation of the Affordable Care Act (ACA), which include regulations addressing employee wellness programs. Currently, the ACA allows employers to offer incentives for employee wellness programs. These include incentives for cessation of smoking, loss of weight, etc. The new rule requires that these programs:
Be reasonably designed to promote health or prevent disease. This means that the program has 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. The program must also have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.
Must be reasonably designed to be available to all similarly situated individuals. This means that reasonable and alternative means of qualifying for the reward 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 set out in the incentive.
Give notice of the opportunity to qualify for the same reward through other means. The proposed rules offer new sample language intended to be simpler for individuals to understand and increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan to request it.
For more information on wellness programs, please contact your Trust Fund counsel.
Author: Conchita Lozano-Batista
