Regulations Aim to Protect Consumers from Unfair Wellness Programs

The Departments of Health and Human Services (HHS), Labor and the Treasury released proposed rules to prohibit unfair practices in wellness programs under group health coverage. The proposed rules would be effective for plan years starting January 1, 2014.

The rules cover “health-contingent wellness programs.” These programs require people to meet a health standard to get a reward. Examples include rewarding people who don’t use tobacco or those who decrease their use; rewarding people who reach a certain cholesterol level or weight; or rewarding people who fail to meet that biometric target, but take certain additional required actions.

Health-contingent wellness programs would have to follow these rules:

• Anyone who does not meet the standard based on the measurement, test, or screening must be offered a reasonable means of qualifying for the reward. Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for people.

• There would have to be reasonable alternative ways to qualify for the reward for people whose medical conditions make it unreasonably difficult to meet the standard or for those whom it would not be medically inadvisable to meet the standard.

• People must be notified of the opportunity to qualify for the same reward through other means. The proposed rules provide new sample language that is intended to be simpler for people to understand, which would increase the likelihood that those who qualify for a different means of getting a reward will contact the plan or issuer to request it.

• The maximum permissible reward under a health-contingent wellness program would increase from 20% to 30% of the cost of health coverage. The maximum reward would increase to as much as 50% for programs designed to prevent or reduce tobacco use.

The proposed rules would not specify the types of wellness programs that employers can offer.

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Last Updated 05/25/2022

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