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Business and Policy Areas
Business and Policy Areas
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Wellness Program Rules Finalized

June 26, 2013

Employer-sponsored wellness programs have surged in popularity in recent years, with 86 percent of employers in a recent survey reporting that they offered wellness-based incentives in 2011. Such programs may get a boost from new rules issued in June under the Affordable Care Act. The rules, issued jointly by the Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services, increase the maximum allowable incentive from 20 to 30 percent of the total cost of group health insurance coverage. And, for programs targeted at helping employees quit smoking, the maximum reward (or penalty) may be as high as 50 percent.

The final rules make distinctions between several types of wellness plans.

  • Participatory wellness programs either don't provide a reward or don't include any conditions for obtaining rewards that require individuals to satisfy a standard relating to a health factor.
  • Health-contingent wellness programs require an individual to satisfy a standard relating to a health factor in order to obtain a reward, or to do more than others need to do based on a health factor. The rules further define two subcategories of these programs. Activity-only programs require the individual to do something (complete an education or exercise program, for instance) but don't require them to meet a specific standard. Outcome-based programs, however, require the individual to attain or maintain a specific health outcome such as not smoking or a certain cholesterol level.

The rules provide a number of safeguards to ensure that individuals are provided alternatives to prescribed activities or standards if they have health-related reasons for not meeting program requirements, and to protect against employers or insurers using wellness programs to discriminate against participants based on their health status.

The new rules apply to insured and self-insured group health plans and take effect for plan years beginning on or after January 1, 2014.

Resources

Towers Watson has a well-written 10-page summary of the final rule.

Contact

Anne Gross
Vice President, Regulatory Affairs
202.861.2544
E-mail

Mary Bachinger
Director, Tax Policy
202.861.2581
E-mail