Corporate Wellness programs – Are They Discrimination?

Kelley-Jensen2Author:  Kelley Filice Jensen

Biometric Screenings in the break room?  Yoga classes at lunch?  “Walking” meetings?  What is going on at work?  Corporate wellness programs are all the rage, and there are two simple reasons:  reducing employee absenteeism  and decreasing health care costs.  But, what if you do not want to participate in a wellness program, can your boss make you?  Isn’t that discrimination?  And, how can they ask you health questions that are private information protected by HIPAA (Health Insurance Portability and Accountability Act)?  Get answers about wellness programs here.

What exactly is a Workplace or Corporate Wellness Program?             

A corporate wellness program is an organized health program intended to help employees and their families make voluntary behavior changes to reduce their health risks.  Formality and design of corporate wellness programs vary greatly from Company to Company, but they all have the goal of improving the health and wellness of their employees.  Some examples are fitness classes on site, weight loss challenges, quitting smoking campaigns, nutrition instruction.

Does these programs really save money for employers, or just create another thing to do?

Yes to both questions.  It definitely creates another job for someone at work, and there is argument that it is not an employer’s business to regulate and participate in health choices of its employees.  However, health care costs associated with an unhealthy workforce have grown to such an unsustainable amount that employers are compelled to participate in some sort of program to encourage employees to be healthy.

How does an unhealthy workforce equate to more cost for employers?

Health insurance rates increases associated with claims filed by health care providers such as doctors and pharmacies.    When employees use their health insurance for conditions such as high blood pressure, diabetes, and other conditions associated with smoking and obesity, the rates an employer pays to maintain the Company health insurance plan go up.

Does the program have to ask me health questions or gather biometric information for me to participate?

As a practical matter, yes.  This information is a starting point to track your progress and your participation in the program.  But, if you are very guarded about your information, you can have your personal physician monitor your progress and still participate in the program.

Isn’t that information private, under HIPAA laws?  What if I do not want my employer to know my weight, blood pressure, etc….?

That information is private, but since your participation in a wellness program can only be voluntary, it is ok for your employer to gather that information. Often though, employers use the services of a third party administrator that helps monitor the wellness program, so they remove access to your private health information.

Can my employer refuse to pay for my health insurance premiums if I do not participate in a wellness program?

No.

Can my employer make me pay more than my coworkers if I choose not to participate?

No, but your employer can offer a reward to coworkers that do participate.

At my work, those that participate in the program get “rewards” that sound a lot like they are paying less than I am for health insurance.  Is that legal?

Yes, as long as the following conditions are met:

1. The total reward is limited; generally, it must not exceed 20 percent of the cost of employee-only coverage under the plan. If dependents (such as spouses and/or children) may participate in the program, the reward must not exceed 20 percent of the cost of the coverage in which an employee and any dependents are enrolled. (increase to 30% effective for plan years beginning on or after January 1, 2014).

2. The program must be reasonably designed to promote health and prevent disease.

3. Those individuals who are eligible to participate in the program must be given an opportunity to qualify for the reward at least once per year.

4. The reward must be available to all similarly situated individuals. The program must allow a reasonable alternative standard (or waiver of initial standard) for obtaining the reward to any individual for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard.

5. The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard or the possibility of a waiver of the initial standard.

 

Group programs that reward individuals who participate in voluntary testing for early detection of health problems and do not use the test results to determine whether an individual receives a reward or the amount of an individual’s reward are permitted under HIPAA’s nondiscrimination provisions. Those programs are not subject to the five requirements for wellness programs that require satisfaction of a standard related to a health factor.

What if I have a medical condition that prevents me from participating?

Employers are prohibited from denying you an opportunity to participate in programs they sponsor.  Your employer must offer you a reasonable accommodation for your participation in a wellness program.

What about Obamacare and wellness programs? I thought that Health Care Reform was supposed to make health insurance affordable for everyone.

That is the goal of Obamacare.  But, another goal of Health Care Reform is prevention.  Preventive medicine, wellness, and not getting a disease or chronic condition that is preventable with lifestyle changes is also a big goal of Health Care Reform.  So, the law encourages employers to participate in such programs.

What if I think it’s a great idea and want to start one at my Company, how can I do that?

Human resources personnel often have a lot on their plate, so if you volunteer to spearhead a wellness program at work, they would be grateful for your enthusiasm.  Contact someone in human resources to see about starting one, chances are, they have information about one, but just have not gotten to it.

What if I refuse to participate? 

Wellness programs can only be voluntary, so you do not need to formally refuse to participate.  But, frankly, lighten up and give it a try!  What do you have to lose, other than some weight.  Work is a logical place to take up wellness:  you spend the most waking hours at work, you eat one, maybe two meals there, and you spend more time with your co-workers than most family members.  These factors make for a successful wellness program because they all aide in developing healthy habits.  And, habits are where it all starts.  Might as well make them good habits.

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