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HIPAA issues wellness program regulations

Final regulations regarding wellness programs under the Health Insurance Portability and Accountability Act (HIPAA) have been issued by the U.S. Department of Treasury, Health and Human Services and the Department of Labor.

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Final regulations regarding wellness programs under the Health Insurance Portability and Accountability Act (HIPAA) have been issued by the U.S. Department of Treasury, Health and Human Services and the Department of Labor.

The regulations clarify how employers and plan sponsors can structure wellness programs.

Among the requirements for acceptable programs:

  • Limit reward sizes to a cost reimbursement, co-pay waiver, or small cash prize, in no case more than 20 percent of the cost of employee-only coverage.
  • Design the program in a way that promotes health or prevents disease.
  • Offer all employees the chance to qualify for a reward at least once a year.
  • Note in all program communications that alternatives or waivers are available to employees who can't meet the standard because of a health factor. The new regs provide sample language for this disclosure, which need not be specific.
  • The regulations note that program design must not only have a reasonable chance of improving health or preventing disease but may be neither too burdensome in terms of time required nor a subterfuge for discrimination based on health. The regulations suggest wellness programs that qualify: full or partial reimbursement of fees for fitness centers; a reward for participating in a diagnostic test (such as blood pressure) that doesn't depend on the result; waiver of co-pays for preventive care such as mammograms or prenatal care; reimbursement for stop-smoking programs even if the employee doesn't stop; and a reward for attending periodic health seminars.