Posted by admin | Posted in Employee Wellness, wellness program | Posted on 26-11-2010
Compliance with HIPAA non-discrimination rules is a large challenge for wellness programs. The old rules were unclear about which incentives passed muster.
That’s all changed, with the rules established earlier this year by the DOL and USA Treasury Department. The rules themselves haven’t changed, but they’ve been clarified. Here’s what you need to know –
‘Participation incentives’ are fine
As long as you structure incentives as rewards for wellness participation, the new rules provide a lot of freedom. All of these are fine under HIPAA –
• reimbursing all or a portion of the cost of gym membership
• financial rewards for undergoing health risk appraisals so long as the reward is based on participation rather than test results
• stimulating preventive care by waiving co-pays or deductibles for these services (i.e., well-baby visits or prenatal care)
• reimbursing workers for the cost of smoking-cessation programs without regard to the result, and
• offering rewards tied to employees attending a monthly health education seminar or working with a wellness Coach.
Conditional rewards OK if…
But what if you want to make the reward conditional on participants meeting specific health goals? Example – Employees who achieve a cholesterol count under 200 get a 20 percent reduction in the cost of their medical plan contributions pending results of an annual cholesterol test.
The feds say it’s OK under health insurance portability and accountability act (HIPAA) to do this, too, but your plan must meet five additional requirements –
• The reward can’t exceed 20% of the cost of employee-only (or, when you allow dependents to participate, employee-plus-dependent) coverage under your health plan.
• The standards should be reasonable (e.g., you can’t limit rewards to folks who can run a marathon). The rewards also can’t be used as a backhanded way to adversely single out certain personnel (e.g., rewards for all non-diabetics).
• Participants must’ve the opportunity to qualify for the reward at least once each year (e.g., a smoker who fails to quit this year gets another chance next year).
• Rewards should be available to all “similarly situated individuals.” In other words, you can’t make a company-compensated weight management program available to certain staff members but not others.
When, for medical reasons, it’s unreasonably difficult for an individual to satisfy conditions that are otherwise reasonable, you must offer an alternative. Example – A pregnant employee might not be able to meet certain standards, so you must offer her an alternative.
Negative incentives violate health insurance portability and accountability act (HIPAA)
So what’s not permitted under HIPAA’s non-discrimination rules? Anything that punishes people for their health conditions or health risks.
The rules prohibit employers from charging different premiums, contributions, co-pays or deductibles based on personal health factors like obesity or use of tobacco. Nevertheless, it’s OK to reimburse these expenditures based on someone’s participation in your health promotion program, without regard to success.
In addition, the feds have added an important new non-discrimination rule – Employers’ health care plans can’t deny benefits for treatment of injuries resulting from a health condition, even when the condition wasn’t diagnosed before the injury.
For instance, some healthcare plans have a “suicide exclusion” that denies payment for treating self-inflicted wounds from a suicide attempt. Now let’s suppose the employee suffers from clinical depression. Even if the depression was undiagnosed before the suicide attempt, it’s illegal for your plan to deny benefits to this employee.