On June 3, 2013, the U.S. Departments of Treasury, Labor, and Health and Human Services released new regulations applicable to wellness programs. The new regulations clarify how the PPACA’s wellness rules interact with pre-existing rules established by the Health Insurance Portability and Accountability Act (“HIPAA”). The new regulations apply to plans and policies, including grandfathered plans, beginning on or after January 1, 2014.
The new regulations draw a distinction between plans that are participatory and plans that are health contingent. Participatory plans are wellness programs that reward participation and are not outcome dependent. Premium reimbursements for fitness membership costs, premium discounts for attending no-cost health education seminars, and rewards for participating (whether successful or not) in smoking cessation programs are examples of wellness programs that should qualify as participatory. Participatory programs do not need to satisfy the HIPAA wellness rule requirements established under the PPACA , but participatory programs may be subject to restrictions under other statutes, such as the Americans with Disabilities Act. Unlike participatory programs, contingent wellness programs, which require the satisfaction of a health standard, need to meet several specific requirements. The potential benefits of operating a health contingent wellness program, along with some of the requirements for operating such programs, will be discussed in this blog’s next entry.
Wellness program operators should review their programs now to ensure their programs will comply with the new regulations before January 1, 2014.