The Affordable Care Act (ACA) uses several avenues to bring down the cost of health care, many of which focus on coordination of care among providers. But another method puts the burden on the individual: the use of employer wellness program.
The Department of Health and Human Services (HHS) claims that evidence shows employer wellness programs have the “potential to promote healthy behaviors, improve employees’ health knowledge and skills…and reduce workplace exposure to substances and hazards that can cause diseases and injury.”
HHS, along with the Departments of Labor and the Treasury, jointly released a proposed rule last week that increases the maximum reward under employer wellness programs from 20 percent to 30 percent of the cost of health coverage. For programs designed to reduce tobacco use, that maximum is increased to as much as 50 percent.
The proposed rule also takes steps to support “participatory wellness programs.” These programs are available to employees regardless of their health status, and provide benefits such as reimbursement of gym membership costs, providing rewards to those who attend health seminars, and rewards to individuals who complete a health risk assessment.
“Health-contingent wellness programs,” on the other hand, require individuals to meet certain health standards before earning a reward. For these programs, the proposed rule outlines a number of requirements, including:
- The program must be reasonably designed to promote health or prevent disease and cannot be “overly burdensome.”
- The program must be available to all similarly situated individuals with alternative means of qualifying for the reward.
- Individuals must be given notice of the opportunity to qualify for the same reward through the other, alternative means.
The proposed rule is located here and would be effective for plans starting January 1, 2014.