ACA made it clear that healthcare and wellness incentives go hand in hand. Well, sort of. Benefits consultants have rolled out programs in a good faith effort to conform to the ACA. However, they have done so with one eye on EEOC action as a result of a conflict with ADA regulations prohibiting such activities.
Here’s the deal: To qualify under ADA and ACA, a wellness program which is part of a group health plan must not be overly burdensome and be designed to promote health or prevent disease. Employees must be given a notice describing:
- the medical information which will be collected and how it will be used
- who will receive the information
- the restrictions on disclosure
- the basic program qualification which must be met and an alternative standard available if unable to qualify due to medical reasons
Financial incentives cannot exceed 30% of the cost of employee-only coverage for wellness and 50% for smoking cessation incentives. And since the program must be voluntary, this must be in the form of incentives for participation and not penalties. Further, the FAQ states that the employer “may not deny access to health coverage or generally limit coverage under its health plan for non-participation” or “may not take any other adverse action… against…employees.”
Employers have generally complied with these new rules, but most are going to need to revise their program and the notices provided. Our wellness team will be busy.