Overview : The webinar will begin by discussing why employers offer wellness programs and a review of the old HIPAA regulations. The webinar will then go into detail on the new definitions under the ACA regulations, specifically: Participatory Wellness Programs, Health-Contingent Wellness Programs, Activity-Only Wellness Programs and Outcome-Based Wellness Programs. The webinar will provide examples of each type of wellness program and how the rules apply differently to each type. It will then review the changes made to the old HIPAA regulations by the new ACA regulations. |
The webinar will go into detail on the types of plans subject to the new rules and the types of financial incentives that are subject to the new rules, the amount of incentives allowed, what constitutes a reasonable design, what the uniform availability rule means, when reasonable alternative standards must be offered and the rules that apply to those standards and the disclosure requirements. The webinar will also review the types of state laws that can affect wellness programs and discuss other federal laws that may also apply. The webinar will conclude with action steps, both for employers that offer wellness programs and those considering offering wellness programs.
HIPAA prohibits using health status to determine eligibility, contributions, or benefits. Neither HIPAA nor the ACA prevents a plan from establishing discounts or rebates, or modifying copayments or deductibles, in return for adherence to a wellness programs. HIPAA nondiscrimination provisions generally prohibit plans from charging similarly situated individuals different premiums based on a health factor. The ACA regulations generally prohibit plans from requiring similarly situated individuals to satisfy different cost-sharing requirements. However, they do not prevent a plan from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles as a reward for members who adhere to health promotion and disease management programs.
A plan may not establish rules for eligibility that discriminate based on health-status-related factors. However, plans may implement wellness programs that provide incentives or rewards to employees who meet certain conditions and that do not provide the same rewards to employees who fail to meet those conditions. The final regulations permit wellness programs to include financial incentives only if they satisfy conditions falling under five headings.
The webinar will describe the rules regarding these five areas, which are: Amount of incentives Reasonable design At least annual qualification for the reward or avoiding the penalty uniform availability and reasonable alternative standards and Disclosure
Because the amount of incentives differs based on whether the incentive is related to tobacco use or other factors, the webinar will describe the definition of tobacco use given as an example in the final regulations.
The webinar will also discuss the GINA rules generally and as they relate to health risk assessments (HRAs). The ADA limits the circumstances under which an employer may require physical examinations or answers to medical inquiries. However, voluntary medical exams and inquiries are permitted as part of an employee health plan if certain criteria are met. The webinar will review these criteria and how they relate to wellness programs.
Why should you attend: High health care costs are driving more and more employers to implement wellness programs in an effort to avoid future large claims. A number of studies show good returns on investment for such programs. Some employers are providing financial incentives or penalties for success or failure related to the wellness programs. Before doing so, employers and other health plan sponsors need to be familiar with the latest regulations. Regulations issued under the Affordable Care Act (ACA) are quite specific as to the rules wellness plans must follow if they are to have any financial incentives.
Running afoul of these rules could have very serious consequences for an employer or trust fund. Fortunately, the rules under the ACA are not too different than the Health Insurance Portability and Accountability Act (HIPAA) rules. The regulations under the Genetic Information Nondiscrimination Act (GINA) add another wrinkle. The Americans with Disabilities Act (ADA) may also affect wellness plans.
To make matters worse, the Equal Employment Opportunity Commission (EEOC) has failed to take a position with regard to the ADA and wellness programs, which means that wellness programs designed to comply with the requirements under HIPAA and PPACA (health care reform) may violate the ADA. So far, only one court has ruled on the applicability of the ADA to wellness plans. Other lawsuits have been filed regarding wellness plans and more lawsuits are to be expected. In an area of uncertainty such as this, it is best for employers and other plan sponsors to be certain they do comply with the rules that exist.
Areas Covered in the Session: Introduction Old Wellness Plan Rules Definitions Participatory Wellness Programs Health-Contingent Wellness Programs Activity-Only Wellness Programs Outcome-Based Wellness Programs State Laws Other Federal Laws Action Steps Questions and Answers
Who Will Benefit: Vice Presidents of Human Resources Human Resource Managers Directors of Compensation and Benefits Benefit Managers Benefit Specialists Employee Benefits Consultants Group Insurance Brokers Employees of Wellness Programs
John Garner is the founding Principal of Garner Consulting, an employee benefit consulting firm in Pasadena. Under Garner’s leadership, this nationally recognized consultancy has built a broad base of services including benefits consulting, claim audits and compliance for insurance companies, employers, health care organizations and providers, and managed care companies. Garner Consulting recently merged its insurance brokerage division with two other brokerage firms to create Valence Benefits, where Garner also serves as a Principal.
Garner has expertise in the area of cost containment and is an acknowledged expert in the field of compliance-particularly the Health Insurance Portability and Accountability Act (HIPAA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Employee Retirement Income Security Act (ERISA).
Prior to founding Garner Consulting in 1987, he was a Principal in the Los Angeles office of Towers Perrin, where he worked for over 10 years. His professional experience also includes managing a group claim office for Lincoln National Life and supervising a claim office for Prudential, where he also served as an underwriter.
He has spoken to many industry organizations, including the International Society of Certified Employee Benefit Specialists, the International Foundation of Employee Benefit Plans and the Employers Health Care Coalition of Los Angeles. Garner is author of the Health Insurance Answer Book and co author of the three-volume Medical/Disability Claims Handbook, and has written numerous published articles. He is active in several professional organizations and has held many distinguished positions on their boards.
Garner earned his BA from Occidental College and holds several designations, including Chartered Life Underwriter, Certified Employee Benefits Specialist, and is a Certified Flexible Compensation Instructor.
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