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Wellness Programs

Nondiscriminatory Wellness Programs

Existing federal labor and health regulations regarding nondiscriminatory wellness programs for group health plans were amended to be consistent with the ACA. The changes will apply to grandfathered and non-grandfathered group health plans and group health insurance coverage for plan years beginning on or after January 1, 2014. Note: The following is a summary of the federal regulation; New York Insurance Law contains a number of barriers to implementing as broad a wellness program.

The regulations establish two wellness program categories:

  • Participatory wellness programs: Programs that do not require the covered person to meet a standard related to a health factor to earn a reward or programs that do not offer a reward at all. Examples include those that pay for gym memberships, those that waive cost-share amounts for prenatal visits, diagnostic testing programs that do not base a reward on test outcomes, and programs that reimburse employees for participating in smoking cessation programs whether the employee quits or not.

  • Health-contingent wellness programs (not permitted in New York state): Programs that require individuals to satisfy a standard related to a health factor to obtain a reward. Standards may include a requirement that the individual attain or maintain a certain health outcome to earn a reward, such as not smoking or meeting exercise targets. These programs are further divided into two categories:

    • Activity-only wellness programs: Walking or dieting programs, for example, are considered contingent because some people may have health conditions that preclude their participation.

    • Outcome-based wellness programs: These programs require participants to not smoke or to attain certain biometric screening results, for example. 

To ensure that health-contingent wellness programs are fair to their participants, the regulations impose the following consumer protection standards:

  • A maximum percentage on permissible rewards
  • A requirement that the program be reasonable in its design
  • A  requirement that individuals have the opportunity to qualify for rewards at least once per year
  • A requirement that the program be uniformly available with reasonable alternative standards
  • A requirement that the program be adequately disclosed

CDPHP offers a variety of wellness programs, including free classes, that encourage employees to live a healthy lifestyle.