HCR Final Rule on Workplace Wellness Programs

Benefits Buzz July 2013

The Affordable Care Act (ACA) includes provisions to encourage appropriately designed, consumer-protective wellness programs in group health coverage.

Effective for plan years beginning on or after Jan. 1, 2014, ACA essentially codifies the existing HIPAA nondiscrimination requirements for health-contingent wellness programs, while also increasing the maximum reward that can be offered under these programs.

Changes for health-contingent wellness programs include an increase in the permissible reward for meeting a health related standard to 30 percent of the total cost of employee-only coverage (or 50 percent, if the program is designed to prevent or reduce tobacco use).

The final regulations formally adopt the proposed nondiscrimination rules for these programs, such as giving individuals an opportunity to qualify for the reward each year and providing an alternative standard or waiver for individuals with health conditions.

The rules also divide these programs into two categories—activity-only wellness programs and outcome-based wellness programs.

The final rules will also continue to support participatory wellness programs, which are generally available without meeting a health related standard.

These programs include programs that reimburse for the cost of membership in a fitness center, that provide a reward to employees for attending a monthly, no-cost health education seminar, or that reward employees who complete a health risk assessment, without requiring them to take further action.

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