The U.S. Departments of the Treasury, Labor and Health and Human Services recently issued final regulations needed to implement the employer wellness program provisions of the Affordable Care Act (ACA). While the rules for participatory wellness programs are unchanged from 2006, those covering health-contingent wellness programs have been expanded.
According to the final regulations, health-contingent programs must now meet 5 requirements, as follows:
- Eligible individuals must be given an opportunity to qualify at least one time per year.
- The reward may not exceed 30% of the total cost of employee-only coverage or 50% if the program is designed to reduce or prevent tobacco use.
- The program must be designed to promote better health or prevent disease.
- In activity-based programs, a reasonable alternative standard must be offered so that individuals with a medical condition are also able to earn the full reward.
- The ability to meet a reasonable alternative standard and qualify for the reward must be disclosed in all materials promoting the wellness program.
These final rules, which are effective for plan years beginning on or after January 1, 2014, apply to grandfathered and non-grandfathered group health plans, whether insured or self-insured.
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In cooperation with NAEBA