Healthcare Reform Act and Corporate Wellness Program Guidelines

Many employers are attempting to improve employees' health and thus, reduce health care costs; and, with the tax incentives available, it just makes dollars and sense to implement a wellness program today.  The focus is on employee health and wellness programs that promote healthier lifestyles or prevent disease.  This article is meant as a starting resource for employers seeking to incorporate a workplace wellness program.  For purposes of this article, a wellness program may be part of a group health plan or may be offered outside of a group health plan.

Step 1:  Programs must be reasonably designed to promote health and/or decrease disease

• A program must offer an alternative for someone who does not fit the "standard" based on testing, measuring or screening, a means to qualify for the reward.
• Programs must have a reasonable chance of improving health or preventing disease.
• Programs must not be overly burdensome to an individual.
• Programs must be designed to be available to all similarly situated individuals (i.e. non-discriminatory).  Reasonable alternatives must be made available where unable or medical inadvisable to an individual.
• Programs must give notice of a means of qualifying for a reward through other means.

Step 2:  Employers must comply with governmental laws and agencies enforced by the EEOC, including ADA

• Employers are restricted in the information they may obtain from employees
• Employers cannot discriminate against individuals with disabilities
• Employers cannot discriminate based on race, color, sex (including pregnancy), nationality, religion, compensation, age or genetic information
• Employers must comply with HIPAA standards

Step 3:  Determine Which Type of Wellness Program to Offer

Participatory Wellness Programs

Participatory wellness programs are not based on achieving a certain health outcome, but are based solely on participation in a program or activity.  These programs are permissible under the HIPAA standards, as long as these programs are provided to all employees.  Examples may include:

• Total or partial reimbursement for a gym membership
• Participation in a smoking cessation program (without regard to whether the employee quits smoking or not)
• Participation in a weight loss program (without regard to whether the employee loses weight or not)
• Participation in a HRA (Health Risk Assessment), without any further action required

Health-Contingent Wellness Programs

Health-contingent wellness programs may be either activity or outcome based.  They require an individual to satisfy a certain health factor in order to obtain a reward, or, require an individual to undertake MORE than a similarly situated individual would in order to obtain the same reward.  

Activity-based programs require an individual to perform or complete an activity related to a health factor in order to obtain a reward.  However, it may not require an individual to attain or maintain a specific heath outcome. 

• Stop smoking or lose weight or actively participate in attempting, whether or not successful 

Outcome-based programs require an individual to attain or maintain a specific health outcome.

• Stop smoking
• Decrease blood pressure or BMI

In order for a health-contingent wellness program to be considered for tax incentives (i.e. deduction or credit), it must meet five criteria:

1. Individuals eligible for the health-contingent program must be given the opportunity to qualify for the reward at least once per year. 
2. The total reward under the health-contingent program cannot exceed 30% of the total cost of the employee-only coverage under the plan, including both employee and employer contributions toward the cost of coverage (or 50% to the extent that is attributable to smoking cessation).  NOTE:  This needs further clarification.
3. The health-contingent program must be reasonably designed to improve health or decrease disease.
4. The full reward under a health-contingent program must be available to all similar situated individuals.
5. Plans and issuers must disclose the availability of a reasonable alternative for activity and outcome based programs.

In the next article on Corporate Wellness Programming, we'll discuss numerous ways of implementing successful programming that conform to all the criteria outlined by the governing agencies.  In the meantime, if you have any questions, please email me at kathy@365fitt.com.

Living 365fitt,
Kathy

365fitt Returns With Focus and Energy

You may have noticed that 365fitt has been "missing in action" for the last nine months or so.  To my blog followers, clients and friends, I need to let you know why.  LIFE got in the way.

As the owner of my own company, I am 365fitt.  I am the "face" of 365fitt and wear all the hats.  I represent the entire marketing, IT, and financial departments; and, one of the responsibilities of the marketing director is to send bi-monthly emails announcing important events and information.  I am also the head coach, events coordinator, and creative writing director, and am responsible for the 365fitt blog providing users with useful health and fitness information in a timely manner.

So, it goes without saying that when something happens to the owner of a small company, the business suffers from lack of attention.  In my case, a series of events, that I will call quite simply, LIFE, caused me to divert my attention from my company to personal matters.  Things happen for a reason, and I truly believe that while attending to these personal matters, while stepping back from 365fitt, I was able to reflect upon and breathe fresh air into 365fitt.  What I came up with was a new business plan that is focused and reflects the current needs of our country.

365fitt has always been about lifetime wellness.  Responding to current statistics from the CDC (Center for Disease Control):

• 35% of adults are overweight or obese
• 20% of adults have diabetes (may be higher)
• 11% of adults have heart disease

And, the costs associated with disease continue to rise:

• National health expenditures in the United States are approximately $3 trillion
• Prescription drugs account for approximately 10% of national health expenditures
• Approximately 80% of companies offer employee wellness programs

Therefore, 365fitt is going to try to make wellness affordable for individuals and companies since the BURDEN of wellness has shifted and will continue to shift to the individual and employee.  It seems that individuals will now have to take responsibility for their health; and potentially, reap a financial reward in the form of an insurance premium rebate or employer incentive.  The Healthcare Reform Act is still relatively new, and everyone - individuals, insurance companies, and employers - are trying to figure out how to decrease their costs.

It's time to think bigger!  365fitt represents a wellness solution in the Living 365fitt 12-Week Program to Lifestyle Wellness (book and video/webinar/podcast series) that can be embraced by millions.  It'll be my job to see it through.  If you'd like to be a part of this movement, please contact me at 630-302-3470 or by email at kathy@365fitt.com.  Here's to better health for all!

Living 365fitt,

Kathy