The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs.
If none of the conditions for obtaining a reward under a wellness program are based on an individual satisfying a standard related to health factor, or if no reward is offered, the program complies with the nondiscrimination requirements (assuming participation in the program is made available to all similarly situated individuals).
For example:
* A program that reimburses all or part of the cost for memberships in a fitness center.
* A diagnostic testing program that provides a reward for participation rather than outcomes.
* A program that encourages preventive care by waiving the copayment or deductible requirement for the costs of, for example, prenatal care or well-baby visits.
* A program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking.
* A program that provides a reward to employees for attending a monthly health education seminar.
Wellness programs that condition a reward on an individual satisfying a standard related to a health factor must meet five requirements described in the final rules in order to comply with the nondiscrimination rules.
The wellness program rules are generally effective for the plan year starting on or after July 1, 2007.
Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.