MediMedia Managed Markets
Managed Care magazine
P&T Community, The Online Resource for P&T Decision Makers
Login / Register
Join Us  Facebook  Twitter  Linked In


News Categories




Obama Administration Issues Final Rules on Employment-Based Wellness Programs

Feds take latest step in implementing health care law (May 29)

The U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury have released final rules on employment-based wellness programs. According to a May 29 announcement, the rules are aimed at supporting workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and limit the growth of health care costs, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.

The final rules continue to support “participatory wellness programs,” which generally are available without regard to an individual’s health status. These 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.

The rules also outline standards for nondiscriminatory “health-contingent wellness programs,” which generally reward individuals who meet a specific standard related to their health. Such programs provide a reward to those who do not use, or decrease their use of, tobacco, or reward those who achieve a specified health-related goal, such as a specified cholesterol level, weight, or body mass index, as well as those who fail to meet such goals but take certain other healthy actions.

According to the HHS, the final rules ensure flexibility for employers by increasing the maximum reward that may be offered under appropriately designed wellness programs, including outcome-based programs. The rules also protect consumers by requiring that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness.

The final rules will be effective for plan years beginning on or after January 1, 2014.

Source: HHS; May 29, 2013.

More stories