These materials are intended for general information purposes only and do not constitute legal advice. The materials sho
build better benefits MAXIMIZE YOUR INVESTMENT
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EMPLOYEE BENEFITS
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KEY CONTACTS Shalina Ann Schaefer
Of Counsel Indianapolis 317-236-2302
[email protected]
icemiller.com
Tara Schulstad Sciscoe Partner Indianapolis 317-236-5888
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Christopher S. Sears
Partner Indianapolis 317-236-5891
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Ice on Fire
WELLNESS PROGRAM COMPLIANCE UNDER FEDERAL LAWS QUICK REFERENCE GUIDE
HIPAA
ADA
GINA
Group Health Plan?
HIPAA’s rules do not apply to wellness programs that are not group health plans.
ADA’s rules apply to wellness programs, even if not a group health plan.
GINA’s rules apply to wellness programs, even if not a group health plan.
Application
Health-contingent wellness programs, such as:
Wellness programs that include:
Wellness programs that provide incentives in exchange for the employee’s spouse’s medical information
Health Insurance Portability and Accountability Act
Incentive Limit
Americans with Disabilities Act
•
HSA seed money based on biometric screening results
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Disability-related inquiries (e.g., health risk assessment) or
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Tobacco-free premium reduction
•
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Rewards for meeting fitness goals
Medical examinations (e.g., annual physical, wellness screening, nicotine test)
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30% of the total cost of applicable tier of coverage (employee plus employer share)
•
30% of the total cost of single coverage (employee plus employer share)
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Limit can increase to 50% for non-tobacco use reward
Genetic Information Nondiscrimination Act
•
30% of the total cost of single coverage (employee plus employer share)
The limits under each law may apply to different components of a wellness program. A non-tobacco use reward that relies on self-certification does not trigger the ADA and may receive the higher incentive provided under HIPAA.
Other Key Requirements
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Must offer a reasonable alternative for obtaining the reward if unreasonably difficult due to a medical condition for activity-only programs and in all cases for outcome-based programs
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Must make reward available annually
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Must disclose the availability of reasonable alternatives in program materials
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Must provide annual written notice of the program in order to satisfy the voluntary standard
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Must obtain written consent from spouse participants before the spouse provides medical information
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Must make accommodations to enable employees with disabilities to earn the full incentive
•
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Confidentiality must be preserved
Cannot collect the employee’s or spouse’s family medical history or any medical information from the employee’s children
These materials are intended for general information purposes only and do not constitute legal advice. The materials should not be used or relied upon as a substitute for a review of applicable statutes, regulations, rulings and court decisions. The reader should consult legal counsel to determine how laws apply to specific situations. These materials were prepared in January 2018, and, consequently, will not reflect changes in law subsequent to that date. Attorney Advertising Material | © 2018 Ice Miller LLP.
