October 17, 2013

Sarah Bassler Millar and Dawn Sellstrom Article Published in Health Law Reporter

Chicago partner Sarah Bassler Millar and counsel Dawn Sellstrom published an article in Health Law Reporter, titled, “Final Wellness Program Rules Bring Health Care Employers New Challenges and Opportunities to Promote Employee Wellness.”

Health care providers, as employers, have been on the leading edge of encouraging healthier lifestyles and wellness among their employees. Some health care providers have also leveraged successful employee wellness programs into new service lines by providing non-health care employers wellness program services. In light of new regulatory guidance, these wellness programs must be re-evaluated and updated.

The Department of Health and Human Services, Department of Labor and Department of the Treasury recently released final regulations clarifying and amending standards for non-discriminatory wellness programs to reflect changes to existing provisions made by the patient Protections and Affordable Care Act of 2010. The final regulations apply to all group health plans and group health insurance coverage for plans years beginning on or after January 1, 2014.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) generally prohibits group health plans and group health insurance issuers from discriminating against individual participants based on health factors. However, wellness programs designed to promote health or prevent disease are excepted from the HIPAA nondiscrimination provisions if they meet certain conditions.

The 2014 final rules maintain the two categories of programs established in the 2006 rules: participatory wellness programs and health-contingent wellness programs.

Participatory wellness programs do not require an individual to satisfy a standard related to a health factor as a condition for obtaining a reward. Health-contingent wellness programs require individuals to satisfy a standard related to a health factor as a condition for obtaining a reward. Health-contingent wellness programs are further divided into activity-only programs and outcome-based programs. Each type of health-contingent program must meet certain requirements to be exempt from HIPAA nondiscrimination provisions.

Sarah and Dawn advise that this is a good time for employers to consider their wellness programs in light of new standards under the 2014 final rules.

To view the article in Health Law Reporter, click here.

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