New wellness regulations may cause headaches

HRS Insight

Starting in 2014, group health plans and insurers will be able to offer higher financial rewards to participants achieving healthy behaviors such as quitting smoking or reducing cholesterol. But these wellness programs will have to avoid discriminating against people based on health factors. Employers offering group health plan-based wellness programs must follow several sets of legal requirements, including HIPAA (health factor discrimination), GINA (genetic information discrimination), and ADA (disability discrimination). The Affordable Care Act (ACA) builds on existing HIPAA wellness program rules for group health plans and extends those nondiscrimination protections to nongrandfathered individual health insurance policies.

New final regulations clarify how wellness programs must be structured to comply with the ACA requirements. While the basic provisions of the regulations proposed late last year are retained, the final regulations include changes aimed primarily at programs that link rewards to activities or outcomes that could be affected by health status. Also released was a RAND Corporation research study commissioned by the Departments of Labor (DOL) and Health and Human Services (HHS) to review workplace wellness programs, upon which the final regulations were partially based. The RAND report contains numerous statistics on wellness plan designs and utilization. The regulations are applicable to both grandfathered and nongrandfathered group health plans and group health insurance coverage for plan years beginning on or after January 1, 2014. The rules also apply to nongrandfathered individual health insurance for policy years starting on or after January 1, 2014.

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