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EEOC Wellness Incentive Proposed Regs are Out!

Summary below. At first glance only major difference from complying with ACA is limit to 30 percent of premium. ACA allows up to 50 percent if smoking cessation is involved. Summary below:

On April 20, 2015, the U.S. Equal Employment Opportunity Commission (EEOC) will publish a Notice of Proposed Rulemaking (NPRM) in the Federal Register that describes how Title I of the Americans with Disabilities Act (ADA) applies to employee wellness programs that are part of group health plans and that include questions about employees’ health (such as questions on health risk assessments) or medical examinations (such as screening for high cholesterol, high blood pressure, or blood glucose levels). Interested members of the public have 60 days from the date of publication of the NPRM to provide comments, or until June 19, 2015. The NPRM is available at https://www.federalregister.gov/articles/2015/04/20/2015-08827/regulations-under-the-americans-with-disabilities-act-amendments. This fact sheet explains the contents of the NPRM.

Wellness programs must be reasonably designed to promote health or prevent disease.

  • They must have a reasonable chance of improving health or preventing disease in participating employees, must not be unduly burdensome to employees, and must not violate the ADA.
  • A program that collects information on a health risk assessment to provide feedback to employees about their health risks, or that uses aggregate information from health risk assessments to design programs aimed at particular medical conditions is reasonably designed. A program that collects information without providing feedback to employees or without using the information to design specific health programs is not.

Wellness programs must be voluntary.

  • Employees may not be required to participate in a wellness program, may not be denied health insurance or given reduced health benefits if they do not participate, and may not be disciplined for not participating.
  • Employers also may not interfere with the ADA rights of employees who do not want to participate in wellness programs, and may not coerce, intimidate, or threaten employees to get them to participate or achieve certain health outcomes.
  • Employers must provide employees with a notice that describes what medical information will be collected as part of the wellness program, who will receive it, how the information will be used, and how it will be kept confidential.

Employers may offer limited incentives for employees to participate in wellness programs or to achieve certain health outcomes.

  • The amount of the incentive that may be offered for an employee to participate or to achieve health outcomes may not exceed 30 percent of the total cost of employee-only coverage.
  • For example, if the total cost of coverage paid by both the employer and employee for self-only coverage is $5,000, the maximum incentive for an employee under that plan is $1,500.

Medical information obtained as part of a wellness program must be kept confidential.

  • Generally, employers may only receive medical information in aggregate form that does not disclose, and is not reasonably likely to disclose, the identity of specific employees.
  • Wellness programs that are part of a group health plan may generally comply with their obligation to keep medical information confidential by complying with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.
  • Employers that are not HIPAA covered entities may generally comply with the ADA by signing a certification, as provided for by HIPAA regulations, that they will not use or disclose individually identifiable medical information for employment purposes and abiding by that certification.
  • Practices such as training individuals in the handling of confidential medical information, encryption of information in electronic form, and prompt reporting of breaches in confidentiality can help assure employees that their medical information is being handled properly.

Employers must provide reasonable accommodations that enable employees with disabilities to participate and to earn whatever incentives the employer offers.

  • For example, an employer that offers an incentive for employees to attend a nutrition class must, absent undue hardship, provide a sign language interpreter for a deaf employee who needs one to participate in the class.
  • An employer also may need to provide materials related to a wellness program in alternate format, such as large print or Braille, for someone with vision impairment.
  • An employee may need to provide an alternative to a blood test if an employee’s disability would make drawing blood dangerous.

2 Responses so far.

  1. Randy Jones says:

    I read briefly through the proposed regs and I need to study them further….still a little confused about the 30% and 50%.
    So the maximum including smoking will move back to 30%. Is that the proposal?
    Also implementation. For plans right now that are beyond the 30% limit, what type of time frame will they have to get back within the new guidelines?
    One last item…. the impact of the amounts on affordability were not discussed. Will the tobacco and participation rewards still not count towards affordability?
    Lots to digest.
    RJones

    • michaeldermer says:

      Here is an article on the regs overall.
      http://michaeldermer.com/wordpress1/?p=2295

      To answer your specific questions:
      1. So the maximum including smoking will move back to 30%. Is that the proposal?

      No. The max is still 50 percent. But smoking programs can only be at 50 percent if they verify the smoking via self-reporting. If a verifying test is required (to verify nicotine) then the 30 percent limit applies. There has been no discussion of implementation timelines yet if this standard changes since the regs are still in proposed form.

      2. One last item…. the impact of the amounts on affordability were not discussed. Will the tobacco and participation rewards still not count towards affordability?

      This does not affect the affordability measure…yet. There was a comment in the regs fromt he EEOC whether they should consider incentives in the affordability standard. Nothing yet but it is on their radar screen.

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