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Wellness programs must comply with the HIPAA and ADA

Published on August 15th, 2013 by Triton Benefits & HR Solutions

Many companies offer wellness programs to their employees in order to promote healthy lifestyles. Under the Affordable Care Act, employers are able to encourage workers to participate in these programs by offering discounts for group health insurance coverage. 

While HR departments must ensure that wellness programs are ACA compliant, that's not the only law that the teams have to consider. The Health Insurance Portability and Accountability Act and the Americans with Disabilities Act both feature provisions regarding health policies. These laws mandate how employers can structure their wellness programs. The following is an examination into how both laws govern wellness programs. 

What the HIPAA stipulates
According to the U.S. Department of Labor, employers cannot charge workers varying amounts for health coverage based on medical conditions under the nondiscrimination provisions. Essentially, this means that workers all have to receive the same prices for insurance. 

Additionally, the DOL explains that wellness programs that don't require workers to meet certain standards to receive rewards or don't offer any incentives are compliant with the HIPAA. As an example, the agency writes that a company that reimburses an employee for a gym membership won't be affected by the nondiscrimination provisions.

For reward-based wellness programs, the goals must be reasonably obtainable and incentives cannot exceed 20 percent of the cost of insurance. There must also be an alternative plan for employees with medical conditions. Lastly, all staff members must be afforded the opportunity to earn rewards at least once every year. 

The ADA's mandates
The U.S. Equal Employment Opportunity Commission explains that it had to clarify certain aspects of the ADA because of the growing prevalence of wellness programs among employers. One of the most important matters was how much medical information companies could seek from disabled staff members. In a panel meeting, Christopher Kuczynski, acting associate legal counsel for the EEOC, stated that employers can ask for any information related to wellness programs

Further, employers must offer reasonable accommodations to all disabled contributors who can't meet the same standards as their colleagues. In a recent letter, Peggy Mastroianni, legal counsel for the EEOC, wrote that companies must allow disabled employees to earn the same rewards as their associates under the ADA, which is similar to the HIPAA's provision regarding alternative standards. Ultimately, this policy is in place to ensure that everyone has access to the same incentives. 

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