ACA Guidelines for Wellness Programs

In the recent election, one of the hot button issues was that of the Affordable Care Act (ACA). With the long election behind us and the results finally in, it appears healthcare reform is here to stay. In the law, passed March 23, 2010 and upheld by the Supreme Court on June 28, 2012, contains provision regarding promoting health and wellness in the workplace.


The U.S. Department of Labor summarized the goal of the recent initiatives regarding wellness programs when they said "Implementing and expanding employer wellness programs may offer our nation the opportunity to not only improve the health of Americans, but also help control health care spending".


As a result of changes to wellness programs made by the ACA, the Departments of Health and Human Services, Labor, and the Treasury have jointly released guidelines of proposed rules to "encourage appropriately designed, consumer-protective wellness programs in group health coverage."


These rules will take effect for plan years starting January 1, 2014. The government's idea is to support "participatory wellness programs," or participation-based programs. These are programs which tie rewards to activities, not to meeting certain health milestones. These will reward things like taking a health risk assessment or going to an informational meeting.


"Health-contingent" or outcomes-based are not ignored by the recent provisions. There are new regulations meant "to protect consumers from unfair practices." There are three new provisions intended to do this. The first is that "programs must be reasonably designed to promote health or prevent disease.


To meet the requirements of a reasonably designed program, a program must a different means of gaining a reward for any individual who does not meet the standard measurement. Also programs must be designed to improve health, but not be too difficult to meet the standards. The second new provision is that programs must available to all "similarly situated individuals," this means that alternative measures must be available for people who, due to medical reasons, cannot participate in the program.


The third and final provision is that people must be made aware that there is an alternative method to qualify for the reward. In the new rules, there is sample language which is "intended to be simpler for individuals to understand and to increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan or issuer to request it."


New support and incentives for outcomes-based programs are with the law as well. A popular one is the increase in the reward is a change from 20 to 30 percent reduction in insurance premiums. This figure is 50 percent for programs which feature tobacco cessation programs. These new provisions are a result of evidence to the effectiveness of wellness programs is promoting healthy behavior, educating employees about their health, and the access they give employees to medical screening and care.


By making the country healthier, preventing disease and limiting exposure to harmful substances the government believes that healthcare costs will decrease. Evidence to the effectiveness of wellness programs supports this idea. The new rules do not rule out any form of wellness program an employee can offer, so employers are free to use the one which is most appropriate to their workplace culture.

About the Authors:

Jonathan Edelheit is the president of Free Health LLC, a leading US and International insurance and healthcare media company that specializes in "niche" industry health insurance, employee benefits and healthcare magazines. Under Free Health LLC, Mr. Edelheit is Editor-in-Chief of Benefits Live Magazine.


The magazine includes four industry-specific publications, including: Corporate Wellness Magazine, the only US and International magazine dedicated to health and wellness in the workplace, the Voluntary Benefits Magazine, the Self Funding Employer Healthcare and Workers Compensation Magazine, and the National Healthcare Reform Magazine, the only magazine dedicated to the newly implemented US Healthcare Reform Law. Daniel Pyne is the assistant editor of Benefits Live, and graduated from Florida State University with a B.A. in International Affairs, and a B.S. in Political Science.