Changes with Wellness Programs for 2014
On May 29, 2013, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) issued Final Rules on wellness program incentives that go into place for new and renewing plan and policy years on or after January 1, 2014. These rules apply to all non-grandfathered fully-insured and self-funded (ASO) plans in the large group market, as well as in the small group market. There may be changes and updates to the rules as questions are asked.
There are five main things that are new in the final rules:
1. There is a new type of health-contingent program called the “activity-only” wellness program. This makes the meaning of “participation-only” wellness programs narrower.
2. Rewards are going up to 30%. Rewards can go up to 50% for people also in programs to help them quit smoking.
3. Notices have to be given to workers that explain health-contingent programs and alternatives.
4. Reasonable alternatives have to be offered to any member in an outcome-based program that cannot meet the standard for any reason Includes “reasonable alternative to a reasonable alternative” if needed.
5. There are new requirements for health-contingent “outcome-based” wellness programs. No doctor verification
*Reasonable alternative must be offered if a person cannot meet the standard for any reason.