Wellness Programs

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Wellness programs got some more teeth from the ACA. Here are the rules.

Overview

The Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces.

The law increases the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage and up to 50 percent for wellness programs designed to prevent or reduce tobacco use.

While participation in a workplace wellness program is one of the few permissible rating factors in the small group market, the final health insurance market rules say that the additional increase in the size of the reward for wellness programs designed to prevent or reduce tobacco use would not be limited to the small group market. This is intended to provide consistency across markets and to provide large group, self-insured, and grandfathered employment-based plans the same additional flexibility to promote tobacco-free workforces as small, insured non-grandfathered health plans.

Sources: DOL Fact Sheet – The Affordable Care Act and Wellness Programs; Final Regulations – Incentives for Nondiscriminatory Wellness Programs in Group Health Plans; Final Health Insurance Market Rules

Regulations and Guidance

Final Regulations
This document contains final regulations regarding nondiscriminatory wellness programs in group health coverage. Specifically, these final regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage. The final regulations further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.
Workplace Wellness Programs Study: Final Report | HHS Cover Letter
At the request of HHS, the Department of Labor (DOL) contracted with the RAND Corporation to help to prepare this report as required by the ACA.
News Release
“Obama administration continues moving forward to implement health care law by releasing final rules on employment-based wellness programs” (5/29/2013)
Proposed Regulations
Description Incentives for Nondiscriminatory Wellness Programs in Group Health Plans (11/26/2012)
A Review of the U.S. Workplace Wellness Market
Description description description description description
Fact Sheet
The Affordable Care Act and Wellness Programs
News Release
“Obama administration moves forward to implement health care law, ban discrimination against people with pre-existing conditions” (11/20/2012)
HHS Final Regulation – Health Insurance Market Rules
Issued February 27, 2013
HHS Proposed Regulation – Health Insurance Market Rules
Issued November 26, 2012
Workplace Wellness Programs Study: Case Studies Summary Report
This report describes findings from four case studies of existing workplace wellness programs in a diverse set of employers. The authors describe characteristics of wellness programs, use of financial incentive and engagement strategies, facilitators and challenges to success, and impact of programs. Case studies were based on data collected through semi‐structured interviews with organizational leaders, focus groups with employees, review of program materials, and direct observation. Prepared by the Rand Corporation (April 2013).

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