HR Management & Compliance

Wellness Programs—What to Know for ACA Compliance

In yesterday’s Advisor, we presented important aspects of wellness programs under the Affordable Care Act (ACA); today, tips on navigating mandatory participation in wellness programs and more ACA regulations.

The Equal Employment Opportunity Commission (EEOC) maintains that participation in wellness programs should be voluntary, since requiring participation could be construed as discriminatory. Mandatory participation requirements could also force employees to submit to non-work-related health screenings and to divulge genetic information in some cases (which could violate other laws). However, the ACA does not clarify the point of whether participation can be mandated. Employers should be aware that the EEOC is watching how they’re implemented. While there are still pending lawsuits that will determine final regulations, this is something to be aware of.

Some More Specific Regulations Under the ACA

For health-contingent programs, these additional specific regulations are outlined in the ACA:

  • The program must be created to either prevent disease or promote health, and it must have a reasonable chance of achieving these goals for those who participate. In other words, it cannot be unreasonably difficult to achieve, and it should not use methods that are highly suspect.


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  • The program must be available to all similarly situated employees, and alternatives must be available for those who have medical conditions that make the minimum standards unreasonably difficult. For example, going back to the BMI reduction program we noted above, if the standard is to achieve a BMI of 26 within a specified time frame in order to get a reduction in insurance costs, it might be unreasonable to expect that achievement in a short time frame for someone who starts with a BMI of 37. This is, of course, just one example. Employers are not required to think of all eventualities, but alternatives must be made available on request. (The regulations specify that the plan must state that there are alternatives available, and it should explain how to request that the minimum standards be waived or altered when applicable.)
  • Employees who are eligible for these types of programs should be able to try to achieve the reward at least once per year.
  • The rewards offered for achieving the health standards in question cannot be more than 30 percent of the cost of the employee health coverage. (This is increased to 50 percent for health-contingent programs related to reducing or stopping tobacco use.)

In summary, employers should be careful in crafting employee wellness programs to remain in legal compliance across the board. This means ensuring that the wellness program benefits meet the guidelines above and allow voluntary participation without going against other related laws.

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Workplace Wellness: Healthy Employees, Healthy Families, Healthy ROI also includes assessment tools, forms, educational materials and handouts which are ideal for training.

You’ll read about:

  • What workplace wellness means—and how it works
  • Profiles of successful workplace wellness programs
  • How to assess the current level of wellness in your business
  • Steps to create, launch, communicate, and assess your own wellness program
  • Helpful forms, training resources, and educational materials
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