On May 17, 2016, the Equal Employment Opportunity Commission (EEOC or the Commission) issued a final rule amending the regulations and related interpretive guidelines (also known as schedules) implementing Title I of the Americans with Disabilities Act (ADA) regarding employer welfare programs. A notice on the proposed rules was already published on April 20, 2015. The final rule states that employers can offer limited financial and other incentives in exchange for an employee`s response to disability-related questions or medical examinations as part of a wellness program, whether or not the program is part of a health plan. Under GINA, it is illegal for an employer to request, solicit or purchase genetic information relating to an employee or family member. There is an exception if the information is part of a wellness program, subject to strict compliance with the following three requirements: In terms of the impact of financial incentives, the report found a median take-up rate of 40% for all types of wellness programs and then compared the experience of limited wellness programs (for example, , which are largely focused on screening) with programs. that offer broader lifestyle and disease management activities and services. He found that financial incentives are associated with a significant increase in employee participation in wellness programs of about 20 percentage points overall, but noted that “developing better programs is almost as effective.” Among programs that do not use financial incentives, the median take-up rate for full programs was 52%, compared to 20% for limited programs (for example, those that offer only health check-ups). The report found no evidence of cost savings among lifestyle program participants who use incentives; Instead, lifestyle program participants` use increased slightly in the first year of participation. The use of financial incentives was associated with lower participation in disease management programs. Finally, the report also found that financial incentives can have unintended consequences by shifting costs to employees in poor health. Similar to the proposed rule, the final rule lists several requirements that must be met in order for an employee`s participation in a wellness program that includes disability-related applications or medical examinations to be considered voluntary. One employer in particular: In 2014, the EEOC took enforcement action against several employers who punished workers who refused to participate in wellness programs that included medical exams. One action involved an employer who used financial incentives to encourage participation.
Employer groups disagreed with these measures, insisting that the ADA be interpreted to allow the use of financial incentives similar to those approved under the ACA/ERISA. The potential of workplace wellness programs to improve health and reduce costs continues to be a major attraction for employers and policy makers. The challenge is to balance this potential with safeguards to ensure that programs do not discriminate against people with health conditions or require the disclosure of health information that people want to keep private. As new regulatory standards come into force and workplace wellness programs advance, the balance between these important goals will also increase. While the effectiveness and fairness of wellness programs remain controversial, regulations are in place to protect workers. These rules ensure that wellness programs are non-discriminatory as much as possible. In 2015, the IRS issued guidelines on this topic. In short, the rules state that for a non-discriminatory tobacco-related wellness program (such as attending smoking cessation classes), the employer may use the cost of coverage after considering compliance with the wellness program to determine whether the health plan meets the affordability rules. Various federal laws and regulations are designed to protect employees and prevent discrimination in the workplace. These include: The general theme of this topic is perception in relation to reality. What may seem simple, based on what a wellness program says, can and probably is more complex than most employers imagine. Federal privacy protections under HIPAA also apply to certain workplace wellness programs.
HIPAA-covered companies include most healthcare providers, healthcare clearing houses, and health plans, including employer-sponsored group health plans, but employers are not HIPAA covered companies. Therefore, the HIPAA Privacy Policy does not apply to wellness programs offered directly by employers outside of a group health plan. Under HIPAA, a group health plan generally cannot share personal health information with an individual`s employer without that person`s permission, but a group health plan may disclose protected health information to the employer without authorization if the employer certifies that the plan protects the information and does not use it for employment-related activities or in conjunction with other benefits. or is transmitted. In the event of an alleged violation of the HIPAA Privacy Policy, individuals may file a complaint with the U.S. Department of Health and Human Services (HHS). there is no private right of action under HIPAA. In the event of a complaint about a workplace wellness program, HHS would investigate and verify that the plan has received the required certifications from the employer. If the group health plan has not received the required certification, HHS could seek civil fines. However, if HHS determined that an employer had breached its promise to use the information received only for lawful purposes, HHS could not enforce against the employer because of the agency`s limited jurisdiction. However, requiring employees to provide medical information about an HRA without providing feedback on risk factors or using aggregate information to design programs or treat specific conditions would not be adequately designed to promote health or prevent disease. Nor is a wellness program reasonably designed to promote health or prevent illness if it simply serves to shift costs from the employer to employees based on their health, or if it is only used by the employer to predict its future health care costs.
Internal Revenue Service; Security management for benefits; Department of Health and Social Services.