HIPAA and Wellness Programs

Employers have many questions about the HIPAA rules as they relate to wellness programs and in particular types of rewards and participation requirements they can have. This week, I will devote two or three posts to the issue of HIPAA and wellness programs .



The big question is, are wellness programs that charge similarly situated individuals different premiums or deductibles allowed under HIPAA's non discrimination rules?



The short answer is yes, but certain requirements have to be met.



None of the conditions for obatining a reward under a wellness program can be based on an individual satisfying a standard related to a health factor. If there are no incentives, the program must comply with nondiscrimination requirements ( this assumes participation is made available to similarly situated individuals).



Examples of programs that pass the test:

• A wellness program that reimburses all or part of the membership cost for a fitness center
• A screening program ( cholesterol, blood pressure etc) that rewards participation, not outcomes. In other words, employees can get a reward for signing up for a screening, but employers may not say that all employees who have normal cholesterol will get a reward.
• Smoking cessation programs where employees are rewarded for participation, but not for quitting.
• Rewarding employees for attending a monthly health education seminar.

Tommorow, I will discuss wellness programs that condition rewards on satisfying a standard related to a health factor.