Authored by John Westercamp
On April 20, 2015, the Equal Employment Opportunity Commission (“EEOC”) published proposed regulations addressing wellness programs. The EEOC estimates that approximately 400,000-600,000 employers offer wellness programs which are regulated by the Americans with Disabilities Act (“ADA”). Smoking cessation programs, weight loss initiatives and health classes are examples of such wellness programs. The proposed regulations aim to provide timely guidance to employers concerning how to navigate the law while administering wellness programs.
The EEOC proposed these regulations because of tension among the ADA, the Health Insurance Portability and Accountability Act (“HIPAA”) and the Affordable Care Act (“ACA”). In the proposed regulations, the EEOC states that “it has a responsibility to interpret the ADA in a manner that reflects both the ADA’s goal of limiting employer access to medical information and HIPAA’s and the Affordable Care Act’s provisions promoting wellness programs.”
A policy underlying HIPAA is to protect the confidentiality of individuals’ health information, while a policy of the ACA is to promote wellness. The ADA generally prohibits employers from medically examining employees or asking questions about employees’ disabilities. The ADA also generally prohibits employers from discriminating against employees based on disability. These different public policies potentially conflict when an employer rewards an employee based on achieving certain health goals. In order to administer the wellness program, the employer may need some medical information about the employee. Moreover, if a wellness program rewards participants based on outcome, this program could be discriminatory against individuals with disabilities.
Voluntary wellness programs are an exception in the ADA to the general prohibition against medical examinations. Therefore, it is critical for employers to understand the definition of “voluntary” to comply with the law. The proposed regulations offer such a definition for employers to consider.
A program is voluntary if it satisfies four requirements: a) the employer does not require employee participation, b) the employer does not deny the employee health plan coverage for not participating, c) the employer does not retaliate against an employee who does not participate or coerce an employee into participating, and d) if the wellness program is part of a health plan, the employer must disclose what medical information of the employee will be shared along with who the information will be shared. If the program meets each of the four requirements, the EEOC considers it “voluntary.” Obviously, voluntarism is only one aspect of compliance with the law.
Wellness programs must also be “reasonably designed to promote health or prevent disease.” A wellness program which is overly burdensome fails this standard. Similarly, a program which is an end run to the ADA or is highly suspect also fails the standard the EEOC proposes. The EEOC likely adopted a “reasonableness” approach to prohibit employers from introducing extreme, novel or questionable wellness programs.
Even if a program reasonably promotes health or prevents disease, the proposed regulations limit the amount of incentives employers may offer employees. If a program involves disability-related inquiries or medical examinations, the program may offer incentives or penalties of up to 30% of the cost of employee-only coverage. A smoking cessation program that merely asks employees whether or not they use tobacco is not an employee health program that includes disability-related inquiries or medical examinations. Accordingly, employers generally may offer rewards of up to 50% of the cost of employee coverage for smoking cessation programs.
Applying the ADA in the wellness program context, employers must make reasonable accommodations to individuals with disabilities so that they may participate in the program and receive the same reward unless the accommodation would be an undue hardship for the employer. Therefore, employers should consider how they can ensure all employees the opportunity to participate in wellness programs. The 2013 final regulations issued by the Departments of Labor, Treasury, and Health and Human Services may be helpful to employers who wish to address this issue.
To protect address the confidentiality of employees’ health information, the EEOC proposes to limit employers’ receipt of employee medical information collected through a wellness program through aggregation. Through aggregation, the information received should not disclose or be likely to disclose individuals’ identities. However, if individualized information is necessary to administer health plans, then the proposed regulation provides an exception.
The proposed regulation also restricts the uses of such medical information. For instance, employee health information collected through a wellness program may not be used to limit insurance eligibility. The EEOC suggests that the best practice to administer a program is to have a person without hiring and firing authority manage the program. This could be achieved through a third party or someone within the company who does not have the ability (or temptation) to fire an individual based on his or her knowledge of the individual’s medical information. These rules and guidance attempt to balance the needs of employer to administer a wellness program against the interest of employees in keeping their medical information confidential.
The proposed regulation is complex, but attempts to resolve the tension among the ADA, HIPAA and the ACA. Clearly the EEOC is attempting to balance the policy of prohibiting discrimination while permitting employers to have flexibility to encourage healthy lifestyles. The proposed regulations have not been finalized and are subject to a comment period; however, the proposed regulations offer employers insight into how the EEOC is currently thinking about enforcement of HIPAA and the ADA.