wellness & the aca: it's not as bad as you fear!

wellnessrebates

©2014 WellnessRebates, LLC. All Rights Reserved.

It’s not as Bad as You Fear!

WELLNESS &

THE ACA:

wellnessrebates

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

2

©2014 WellnessRebates, LLC. All Rights Reserved.

How Did We Get Here?

1. 1996 – HIPAA – group health plans and issuers cannot

� ÚĜŸÏųĜĵĜűƋå�ĜĹ�åĬĜčĜÆĜĬĜƋƼØ�ÆåĹåĀƋŸ�Ņų�ŞųåĵĜƚĵŸ�ƱŸåÚ�ŅĹ� health factor

a. Exception: Rewards for adherence to a

wellness program

2.� ƖLjLjƅ��åčƚĬ±ƋĜŅĹŸ�ô��Ĭ±ųĜĀåÚ�ƵåĬĬĹ域�ŞųŅčų±ĵ�ųƚĬåŸ�±ĹÚ� established standards for qualifying for HIPAA exception

3. ƖLjŎLj�ô�{±ƋĜåĹƋ�{ųŅƋåÏƋĜŅĹ�±ĹÚ�eýŅųÚ±ÆĬå��±ųå�eÏƋ� (“PPACA” or “ACA”)

a. Increased allowable incentive amounts and

� � � ÏĬ±ųĜĀåÚ�ƖLjLjƅ�ųåčƚĬ±ƋĜŅĹŸ b. First draft – November 2012

c. Final rules:

i. Released – May 29, 2013

ii.�)ýåÏƋĜƴå�ŅĹ�±ĬĬ�čųŅƚŞ�ŞĬ±ĹŸ�ŠĜĹÏĬƚÚĜĹč��� � � grandfathered) - Jan 1, 2014

Why Wellness Regs Part of PPACA?

1. Wellness programs becoming more common

a. ƖLjŎƖ�ô�ƅƐŢ�Ņü�±ĬĬ�åĵŞĬŅƼåųŸ�ŅýåųåÚ�ƵåĬĬĹ域�ŞųŅčų±ĵ�ŠU±ĜŸåųxB�)��ŸƚųƴåƼš

2. Employers increasing use of wellness incentives

a. 2012 – 87% of employers with >200ees plan to add or strengthen incentive programs

(2012 Mercer Survey)

b. Incentives above $50 tied to increased participation in wellness programs and

� � � ĜĹÏåĹƋĜƴåŸ�±ÆŅƴå�âƖLjLj�ʱƴå�ŸƋ±ƋĜŸƋĜϱĬĬƼ�ŸĜčĹĜĀϱĹƋ�åýåÏƋ�ŅĹ�ƵåĜčĘƋ�ĬŅŸŸØ�åƻåųÏĜŸå�±ĹÚ�� smoking outcomes (RAND Corp)

3. Government “believes that appropriately-designed wellness programs have the potential to

contribute importantly to promoting health and preventing disease.”

Objective of Final Regulations

�Ņ�åŸƋ±ÆĬĜŸĘ�ÏųĜƋåųĜ±�ƋʱƋ�ĵƚŸƋ�Æå�Ÿ±ƋĜŸĀåÚ�üŅų�ƵåĬĬĹ域�ŞųŅčų±ĵŸ�ƋŅ�ŧƚ±ĬĜüƼ�üŅų�BF{ee�åƻÏåŞƋĜŅĹ�(i.e. to be found as non-discriminatory)

1. eĹ�±þųĵ±ƋĜƴå�ÚåüåĹŸå�±ƴ±ĜĬ±ÆĬå�ƋŅ�ŞĬ±ĹŸ�±ĹÚ�ĜŸŸƚåųŸ�ĜĹ�ųåŸŞŅĹŸå�ƋŅ�ÚĜŸÏųĜĵĜűƋĜŅĹ�ÏĬ±Ĝĵ��� under HIPAA

2.����ñ�ÚŅåŸ�ck��ĹåÏ域±ųĜĬƼ�ŞųŅƋåÏƋ�±č±ĜĹŸƋ�ŅƋĘåų�üåÚåų±Ĭ�Ņų�ŸƋ±Ƌå�åĵŞĬŅƼåå�ÆåĹåĀƋØ�� � discrimination and privacy laws (examples: ERISA, GINA, ADA, etc.)

�e�U:�k�c%xFc��k%���Fkc

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

3

©2014 WellnessRebates, LLC. All Rights Reserved.

Reward

1.� kÆƋ±ĜĹĜĹč�±�ųåƵ±ųÚ a. Discount or rebate of premium contribution

b. Waiver of all or part of cost sharing (examples: deductible, copayment or coinsurance)

c. eĹ�±ÚÚĜƋĜŅűĬ�ÆåĹåĀƋ�Šåƻ±ĵŞĬå×�ޱĜÚ�ƋĜĵå�Ņýš d. Financial incentive

2. Avoiding a penalty

a. Premium surcharge

b.�kƋĘåų�ĀűĹÏĜ±Ĭ�Ņų�ĹŅĹěĀűĹÏĜ±Ĭ�ÚĜŸĜĹÏåĹƋĜƴå�

Two Types of Wellness Incentive Programs

1. Participatory

a. Reward, or conditions for obtaining

reward, unrelated to a “health factor”

(examples: health status, injury, illness,

risk factors like BMI, cholesterol,

glucose, BP, smoking)

b. Majority of wellness programs

c. Examples: Gym reimbursement,

health screening (regardless of

results), attending seminars, etc.

2. Health contingent

a. Reward tied to a health factor

i. )ĵŞĬŅƼåå�ĵƚŸƋ�Ÿ±ƋĜŸüƼ�ŸƋ±ĹÚ±ųÚ�ųåĬ±ƋåÚ�ƋŅ�±�Ęå±ĬƋĘ�ü±ÏƋŅų�k� 1. Examples:

a.�ĵååƋ�ŸŞåÏĜĀÏ��aF�Ņų�ÏĘŅĬåŸƋåųŅĬ�Ƌ±ųčåƋ� b. walking or exercise program

ii. Additional requirement due to existence of a health factor

1. Example: because of cholesterol, must complete education seminar

b.��ƵŅ�ƋƼŞåŸ�Ņü�Ęå±ĬƋĘ�ÏŅĹƋĜĹčåĹƋ�ƵåĬĬĹ域�ŞųŅčų±ĵŸ�ŠĹåƵ�ĜĹ�ĀűĬ�ųåčŸš i. Activity only

ii.�kƚƋÏŅĵåěƱŸåÚ

� � � � �Ņ�ųåÏåĜƴå�ųåƵ±ųÚØ�ƵåĬĬĹ域�ŞųŅčų±ĵ�ųåŧƚĜųåŸñ 1) Completing an HRA =

2) Average 10,000 steps a day =

3) Smoking cessation program for smokers =

4) Stress management class for all interested employees =

%)8FcF�Fkc�

Q

QUIZ I – Participatory or Health Contingent?

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

4

©2014 WellnessRebates, LLC. All Rights Reserved.

Two Types of Health Contingent Wellness Incentives

1. Activity only

a. �Ņ�ŅÆƋ±ĜĹ�ųåƵ±ųÚ×��åŧƚĜųåÚ�ƋŅ�ŞåųüŅųĵ�Ņų�ÏŅĵŞĬåƋå�±Ĺ�±ÏƋĜƴĜƋƼ�ųåĬ±ƋåÚ�ƋŅ�±�Ęå±ĬƋĘ�ü±ÏƋŅų� i.�eÏƋĜƴĜƋƼ�ųåĬ±ƋåÚ�ƋŅ�Ęå±ĬƋĘØ�ÆƚƋ�%k)��ck��ųåŧƚĜųå�±ÏĘĜåƴĜĹč�ŸŞåÏĜĀÏ�Ęå±ĬƋĘ�ŅƚƋÏŅĵå 1. Examples: Walking, diet or exercise program

ii. Related to a health factor because some people may not be able to participate (or

� � � � � ʱƴå�ÚĜþÏƚĬƋƼ�ޱųƋĜÏĜޱƋĜĹčxÏŅĵŞĬåƋĜĹčš�ÆåϱƚŸå�Ņü�±�Ęå±ĬƋĘ�ÏŅĹÚĜƋĜŅĹ 1. Example: can’t complete walking program due to pregnancy, surgery, asthma

2.�kƚƋÏŅĵåěƱŸåÚ a.��Ņ�ŅÆƋ±ĜĹ�ųåƵ±ųÚ×��åŧƚĜųåÚ�ƋŅ�±ƋƋ±ĜĹ�Ņų�ĵ±ĜĹƋ±ĜĹ�±�ŸŞåÏĜĀÏ�Ęå±ĬƋĘ�ŅƚƋÏŅĵå� i. Examples: Not smoking, healthy BMI, healthy cholesterol, etc.

b. Generally have 2 Tiers:

i. Tier 1: Measurement, test or screening that evaluates medical condition or

risk factor

1. �åƵ±ųÚ�čĜƴåĹ�ƋŅ�åĵŞĬŅƼååŸ�ƵĘŅ�ĵååƋ�ŸŞåÏĜĀåÚ�Ęå±ĬƋĘ�ŅƚƋÏŅĵå ii. Tier 2: Additional wellness programing or health standard targeted to those who

� � � � � ÚŅ�ĹŅƋ�ĵååƋ�ŸŞåÏĜĀåÚ�Tier 1 health outcome

1. “Reasonable Alternative Standard” (see below)

2.��±Ĺ�Æå�±ÏƋĜƴĜƋƼ�k��ŅƚƋÏŅĵåěƱŸåÚ�ųåŧƚĜųåĵåĹƋ c. Examples: Health screening or HRA to determine diabetes risk. Healthy glucose

receives reward. Unhealthy glucose = must attend diabetes risk seminar to obtain

same reward.

� � � � �Ņ�ųåÏåĜƴå�ųåƵ±ųÚØ�ƵåĬĬĹ域�ŞųŅčų±ĵ�ųåŧƚĜųåŸñ 1) Smoking cessation program for tobacco users =

2) Averaging 2 workouts a week, open to everyone =

3) Averaging 2 workouts a week, for those with BMI>30 =

4) Dropping BMI by 5% for those with BMI>30 =

� � � � � Ăš��ŅĵŞĬåƋĜŅĹ�Ņü�ĂU�÷�

Q

}�F¬�FFô�eÏƋĜƴĜƋƼ�kĹĬƼ�Ņų�kƚƋÏŅĵåě�±ŸåÚũ�

%)8FcF�Fkc�

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

5

©2014 WellnessRebates, LLC. All Rights Reserved.

HIPAA Exception for Participatory

1. Wellness program must be made available to all similarly

situated individuals, regardless of health status

a. No health status requirement = no discrimination

b.��ųå±Ƌ�åƴåųƼŅĹå�ƋĘå�Ÿ±ĵåú i. )ƻ±ĵŞĬå×�)±ųĹ�âŎLjLj�üŅų�ÏŅĵŞĬåƋĜĹč�Ęå±ĬƋĘ�ŸÏųååĹĜĹčú 1.�kŞåĹ�ƋŅ�±ĬĬ�åĵŞĬŅƼååŸ�÷�kU 2. kŞåĹ�ƋŅ�ŅĹĬƼ�ĵ±Ĺ±čåĵåĹƋ�÷�ck��kU 3.�kŞåĹ�ƋŅ�ŅĹĬƼ��aF�IJ�ƐLj�÷�ck��kU 4.�eƴ±ĜĬ±ÆĬå�ŅĹĬƼ�±Ƌ�ƅŞĵØ�ÆƚƋ�IŅĘĹ�ϱĹűƋ�ĵ±ĩå�ĜƋ�÷�kU

HIPAA Exception for Health-Contingent

1. Five requirements for both activity-only and outcome-based

a. Frequency of reward - Must give employees opportunity to qualify at

least once a year

I. Full reward must be given to anyone who meets standard in calendar year

1.��åƋųŅ±ÏƋĜƴå�Ņų�ŞųŅěų±Ƌ±�±üƋåų�ŸƋ±ĹÚ±ųÚ�ĜŸ�ĵåƋØ���� 2. All payments must be awarded within year (No pro-rata into following year)

b. Size of reward i. Employee-only wellness program

1. No more than 30% of total cost of employee-only plan

a. )ƻÏåŞƋĜŅĹ×��ŅƱÏÏŅ�÷�ĂLjŢ ii. �ŞŅƚŸåŸxÚåŞåĹÚåĹƋŸ�ĜĹ�ƵåĬĬĹ域�ŞųŅčų±ĵ 1. No more than 30% of total cost of plan enrolled

b.�)ƻÏåŞƋĜŅĹ×��ŅƱÏÏŅ�÷�ĂLjŢ 2. )ƻ±ĵŞĬå×��ŅƋ±Ĭ�ĜĹÏåĹƋĜƴå�±ƴ±ĜĬ±ÆĬå�ƋŅ�åĵŞĬŅƼåå�±ĹÚ�ÚåŞåĹÚåĹƋ�ϱĹĹŅƋ�åƻÏååÚ��� � � � � � ƐLjxĂLjŢ�Ņü�åĵŞĬŅƼåå�ť��ĘĜĬÚØ�åĵŞĬŅƼåå�ť��ŞŅƚŸå�Ņų�ü±ĵĜĬƼ�ŞĬ±Ĺ iii. �ŅƋ±Ĭ�ÏŅŸƋ�÷�)ĵŞĬŅƼåå�ť�)ĵŞĬŅƼåų�ÏŅĹƋųĜÆƚƋĜŅĹŸ c. Reasonably designed to promote health or prevent disease i. Broad requirements:

1. �屟ŅűÆĬå�ÏʱĹÏå�Ņü�ĜĵŞųŅƴĜĹč�Ęå±ĬƋĘxŞųåƴåĹƋĜĹč�ÚĜŸå±Ÿå�ĜĹ�ޱųƋĜÏĜޱĹƋŸ 2. Not overly burdensome

3. Not “subterfuge” for discrimination

4. cŅƋ�ŮĘĜčĘĬƼ�ŸƚŸŞåÏƋŰ�ĜĹ�ĵåƋĘŅÚ�ÏĘŅŸåĹ�ƋŅ�ŞųŅĵŅƋå�Ęå±ĬƋĘxŞųåƴåĹƋ�ÚĜŸå±Ÿå ii. {ųŅĵŅƋåŸ�āåƻĜÆĜĬĜƋƼxåƻŞåųĜĵåĹƋ±ƋĜŅĹ 1. Based on facts & circumstances – regs do not require adherence to any

� � � � � � ŸŞåÏĜĀϱĬĬƼ�ÚåŸĜčĹåÚ�ƵåĬĬĹ域xĵåÚĜϱĬ�ŸƋ±ĹÚ±ųÚŸ 2. Many resources describing best practices (Joint Consensus Statement;

WellnessRebates Webinar)

}�eXF8¥Fc:�8k��BF{ee�)£�){�Fkc

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

6

©2014 WellnessRebates, LLC. All Rights Reserved.

d. Uniform availability - Full reward must be available to all similarly-situated individuals

i. For all health-contingent:

1. Must provide reasonable alternative standard (“RAS”) or waiver for those who:

a.� �Ĺų屟ŅűÆĬƼ�ÚĜþÏƚĬƋ�ƋŅ�ĵååƋ�ŸƋ±ĹÚ±ųÚ�Úƚå�ƋŅ�ĵåÚĜϱĬ�ÏŅĹÚĜƋĜŅĹ b. Medically inadvisable to attempt to meet standard

2. Special rule for outcome-based (see below)

3.�kÆģåÏƋĜƴå�ô�)ƴåųƼŅĹå�čåƋŸ�±�ŸĘŅƋ�±Ƌ�ųåƵ±ųÚØ�ųåč±ųÚĬ域�Ņü�Ęå±ĬƋĘ�ü±ÏƋŅų ii. No need to seek out those who qualify for RAS or waiver, but must grant if

� � � � � åĵŞĬŅƼåå�ųåŧƚåŸƋŸ�±ĹÚ�ŧƚ±ĬĜĀåŸ iii. Reasonableness of alternative standard based on facts and circumstances, but

some special rules (see below)

e. Notice requirements

i. kĹĬƼ�±ŞŞĬĜåŸ�ƋŅ×�{Ĭ±Ĺ�ĵ±ƋåųĜ±ĬŸ describing terms of health-contingent wellness

program (not just mentioning that program exists)

1. �åųĵ�÷�åƻĜŸƋåĹÏå�Ņü�ŞųåĵĜƚĵ�ÚĜýåųåĹƋĜ±ĬØ�ŸƋ±ĹÚ±ųÚŸ�Ņü�ƵåĬĬĹ域� program, etc.

ii. Notice must disclose:

1. availability of reasonable alternative standard or possibility of waiver

2. ÏŅĹƋ±ÏƋ�ĜĹüŅ�üŅų�ŅÆƋ±ĜĹĜĹč�ų屟ŅűÆĬå�±ĬƋåųűƋĜƴå�ŸƋ±ĹÚ±ųÚxƵ±Ĝƴåų 3. statement that recommendations of personal physician will be

accommodated

Special Rules

1.� kƚƋÏŅĵåěƱŸåÚ a. Reasonable design & uniform availability

i.� aƚŸƋ�ʱƴå��Ĝåų�Ɩ×�aƚŸƋ�ŞųŅƴĜÚå�ų屟ŅűÆĬå�±ĬƋåųűƋĜƴå�ŸƋ±ĹÚ±ųÚ�Ņų�Ƶ±Ĝƴåų�üŅų�� �� � � � � )�)�¥kc)�ƵĘŅ�ü±ĜĬŸ�ƋŅ�ĵååƋ�ĜĹĜƋĜ±Ĭ�ĵ屟ƚųåĵåĹƋØ�ƋåŸƋ�Ņų�ŸÏųååĹĜĹč�ŸƋ±ĹÚ±ųÚ 1.�Fü�Ů�Ĝåų�ƖŰ��e��ĜŸ�±ÏƋĜƴĜƋƼěŅĹĬƼ× a.� aƚŸƋ�ŞųŅƴĜÚå�±ÚÚĜƋĜŅűĬ��e�xƵ±Ĝƴåų�üŅų�ƚĹų屟ŅűÆĬƼ�ÚĜþÏƚĬƋ�Ņų�� � � medically inadvisable

2.�Fü�Ů�Ĝåų�ƖŰ��e��ĜŸ�ŅƚƋÏŅĵåěƱŸåÚ× a. Must provide additional time to meet standard, taking to account

individual circumstances

i.� )ƻ±ĵŞĬå×�Fü��Ĝåų�Ŏ�ĜŸ��aF�IJƐLjØ��Ĝåų�Ɩ�ϱĹĹŅƋ�Æå��aF�IJƐŎ�ŅĹ�Ÿ±ĵå�Ú±Ƌå b. Must allow compliance with doctor recommendation as RAS if doctor

joins the request

i. Employee can request compliance with doctor recommendations at

any time

ii. Doctor can adjust recommendation at any time, consistent with

medical appropriateness

b.�cŅƋĜÏå�ųåŧƚĜųåĵåĹƋ�ô��åŧƚĜųåŸ�ÚĜŸÏĬŅŸƚųå�Ņü��e�x�±Ĝƴåų�ĜĹ�ĹŅƋĜÏå�ƋŅ�åĵŞĬŅƼåå�� �� � � ĜĹüŅųĵĜĹč�ƋʱƋ�ÚĜÚ�ĹŅƋ�ĵååƋ��Ĝåų�Ŏ�ŸƋ±ĹÚ±ųÚ

}�eXF8¥Fc:�8k��BF{ee�)£�){�Fkc

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

7

©2014 WellnessRebates, LLC. All Rights Reserved.

2. �屟ŅűÆĬåĹ域�Ņü��e��ô�:åĹåų±ĬĬƼ�ƱŸåÚ�ŅĹ�ü±ÏƋŸxÏĜųÏƚĵŸƋ±ĹÏåŸØ�ÆƚƋ�ŸŅĵå� special rules:

a. If RAS is completion of education program:

i.� )ĵŞĬŅƼåų�ĵƚŸƋ�ĵ±ĩå�ŞųŅčų±ĵ�±ƴ±ĜĬ±ÆĬå�Ņų�±ŸŸĜŸƋ�ĜĹ�ĀĹÚĜĹč�ŞųŅčų±ĵ ii. Employer must pay for cost of program

iii. �Ĝĵå�ÏŅĵĵĜƋĵåĹƋ�ĵƚŸƋ�Æå�ų屟ŅűÆĬå� 1. Example in regs: nightly attendance for 1 hour class is unreasonable

b. If RAS = Diet program

i. Employer must pay membership or participation fee

ii.�)ĵŞĬŅƼåų�ck��ųåŧƚĜųåÚ�ƋŅ�ޱƼ�üŅų�üŅŅÚ3. Wellness programs and doctor’s notes:

a. Fü�ų屟ŅűÆĬåØ�åĵŞĬŅƼåų�ĵ±Ƽ�Ÿååĩ�ƴåųĜĀϱƋĜŅĹ�üųŅĵ�åĵŞĬŅƼååűŸ�ÚŅÏƋŅų�ƋʱƋ�� � �� � � ŸƋ±ĹÚ±ųÚ�ĜŸ�ƚĹų屟ŅűÆĬƼ�ÚĜþÏƚĬƋ�Ņų�ĵåÚĜϱĬĬƼ�ĜűÚƴĜŸ±ÆĬå i. Applies to initial standard or established RAS

ii. )ƻ±ĵŞĬå×�%ŅĹűƋ�ʱƴå�ƋŅ�Ƌ±ĩå�åĵŞĬŅƼååűŸ�±Ƌ�ƵŅųÚţ�kU�ƋŅ�Ÿååĩ�ƴåųĜĀϱƋĜŅĹ�ƵĘåĹ�� � medical judgment is required to establish validity of employee’s request

b. If employee’s doctor says RAS is not medically appropriate, must provide RAS

that is compliant with doctor’s recommendations

i. �Ƌ±ĹÚ±ųÚ�ÏŅŸƋěŸĘ±ųĜĹč�üŅų�ųåÏŅĵĵåĹÚåÚ�ŸåųƴĜÏåŸxĵåÚĜÏĜĹåxÚåƴĜÏåŸ�ƚĹÚåų�� �� � � � � ŞĬ±Ĺ�ĜŸ�kU� c. kƚƋÏŅĵåě�±ŸåÚ×� i. �Ĝåų�Ŏ×��±ĹĹŅƋ�ÏŅĹÚĜƋĜŅĹ�ŅýåųĜĹč��Ĝåų�Ɩ��e��ŅĹ�ÚŅÏƋŅųűŸ�ĹŅƋå� 1.�)ƴåųƼŅĹå�ƵĘŅ�ü±ĜĬŸ�ƋåŸƋ�ĵƚŸƋ�Æå�ŅýåųåÚ���e� ii. �Ĝåų�Ɩ×�aƚŸƋ�±ĬĬŅƵ�ÏŅĵŞĬĜ±ĹÏå�ƵĜƋĘ�ÚŅÏƋŅų�ųåÏŅĵĵåĹÚ±ƋĜŅĹ�±Ÿ��e��Ĝü�ÚŅÏƋŅų�� � joins the request

1. Employee can request compliance with doctor recommendations at any time

2. Doctor can adjust recommendation at any time, consistent with medical

appropriateness

}�eXF8¥Fc:�8k��BF{ee�)£�){�Fkc

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

8

©2014 WellnessRebates, LLC. All Rights Reserved.

)£ea{X)��ě��e���åŧƚĜųåĵåĹƋŸ�üŅų�{±ųƋĜÏĜޱƋŅųƼ�±ĹÚ�kƚƋÏŅĵåě�±ŸåÚ

ie Example 1:

a. Facts: �£¥¬��ŅųŞ�ŅýåųŸ�âŎLjLjLj�üŅų�±ĹƼ�åĵŞĬŅƼåå�ƵĘŅ�±ƴåų±čåŸ�ŎLjØLjLjLj�ŸƋåŞŸxÚ±Ƽ��Ņƴåų�Ɛ�ĵŅĹƋĘŸţ�cŅƋĜÏå�±ĹĹŅƚĹÏĜĹč�ųåƵ±ųÚ�Ÿ±ƼŸ�£¥¬��ŅųŞ�ƵĜĬĬ�Ƶ±Ĝƴå�ƋĘå�ųåŧƚĜųåĵåĹƋ�±ĹÚ�ŞųŅƴĜÚå�ųåƵ±ųÚ�ƋŅ�±ĹƼŅĹå�üŅų�ƵĘŅĵ�ƚĹų屟ŅűÆĬƼ�ÚĜþÏƚĬƋ�Ņų�ĵåÚĜϱĬĬƼ�ĜűÚƴĜŸ±ÆĬå�Úƚå�ƋŅ�ĵåÚĜϱĬ�ÏŅĹÚĜƋĜŅĹţ�Iåý�Ƶ±Ÿ�ŸĩĜĜĹč�±ĹÚ�ÆųŅĩå�ĘĜŸ�Ĭåčţ�Bå�ĜĹüŅųĵŸ�£¥¬��ŅųŞØ�ųåÏåĜƴåŸ�Ƶ±Ĝƴåų�±ĹÚ�âŎLjLjLjţ�IƚÚƼ�ųåÏŅƴåųĜĹč�üųŅĵ�±ĹĩĬå�ŸƚųčåųƼØ�±ĹÚ�ÚŅÏƋŅų�Ÿ±ƼŸ�ŸĘå�ϱĹĹŅƋ�Ƌ±ĩå�ŎLjU�ŸƋåŞŸØ�ÆƚƋ�ϱĹ�Ƌ±ĩå�ĂUxÚ±Ƽ�ŸƋåŞŸţ�£¥¬�üŅĬĬŅƵŸ�ÚŅÏƋŅų�ųåÏŅĵĵåĹÚ±ƋĜŅĹ�±ĹÚ�ƵĘåĹ�IƚÚƼ�±ƴåų±čåŸ�ĂU�ŸƋåŞŸxÚ±ƼØ�ŸĘå�receives $1000.

b. �±ƋĜŸĀåŸ��e��ųƚĬåŸũ�¥åŸØ�ÆåϱƚŸå�±ÏÏŅĵĵŅÚ±ƋåŸ�ƋĘŅŸå�ƵĜƋĘ�ĵåÚĜϱĬ�ÏŅĹÚĜƋĜŅĹŸ�±ĹÚ�ŅýåųŸ�everyone the opportunity to obtain reward, regardless of health factor.

Example 2:

a. Facts: �ĜƋƼ�Ņü�kDŽ�ŅýåųŸ�âĂLjxĵŅĹƋĘ�ŞųåĵĜƚĵ�ÚåÚƚÏƋĜŅĹ�üŅų�±ĬĬ�åĵŞĬŅƼååŸ�ƵĜƋĘ��aF�IJƐLjţ�%ŅųŅƋĘƼ�±ƋƋåĹÚŸ�ŸÏųååĹĜĹčØ�ʱŸ��aF�Ņü�ƐƖØ�±ĹÚ�ÚŅåŸ�ĹŅƋ�ųåÏåĜƴå�ÚåÚƚÏƋĜŅĹţ��ĜƋƼ�Ņü�kDŽ�ÚŅåŸ�ĹŅƋ�Ņýåų�±ĹƼ�ŞųŅčų±ĵŸ�Ņų�ŅŞŞŅųƋƚĹĜƋĜåŸ�üŅų�åĵŞĬŅƼååŸ�ƵĜƋĘ��aF�ēƐLj�ƋŅ�å±ųĹ�ÚåÚƚÏƋĜŅĹØ�ƚĹƋĜĬ�ĹåƻƋ�year’s screening.

b. �±ƋĜŸĀåŸ��e���ƚĬåŸũ�cŅØ�ÆåϱƚŸå�ÚŅåŸ�ĹŅƋ�ŞųŅƴĜÚå��Ĝåų�Ɩ��e��ƋʱƋ�±ĬĬŅƵŸ�åĵŞĬŅƼååŸ�ƵĜƋĘ��aF�ēƐLj�ƋŅ�å±ųĹ�ųåƵ±ųÚţ�cŅƋå×��ĘĜŸ�ĜŸ�åƻ±ÏƋĬƼ�ƵʱƋ�ųåčŸ�±ųå�ĵå±ĹƋ�ƋŅ�±ƴŅĜÚţ�FĹƋåĹƋĜŅĹ�ĜŸ�ƋŅ�ŞųŅĵŅƋå�progress, by allowing employees who do not satisfy initial health standard an opportunity to

earn reward by showing improvement (example: meeting lower outcome-based standard, like

dropping 5% of body weight or completing educational program on healthy eating).

Example 3:

a. Facts: �ĜƋƼ�Ņü�kDŽ�ŅýåųŸ�âĂLjxĵŅĹƋĘ�ŞųåĵĜƚĵ�ÚåÚƚÏƋĜŅĹ�üŅų�±ĬĬ�åĵŞĬŅƼååŸ�ƵĜƋĘ��aF�IJƐLjţDorothy attends screening, has BMI of 32, and does not receive deduction. Notice describing

ŞųŅčų±ĵ�Ÿ±ƼŸ�±ĹƼŅĹå�ƵĜƋĘ��aF�ēƐLj�ϱĹ�ųåÏåĜƴå�âĂLjxĵŅĹƋĘ�ÚåÚƚÏƋĜŅĹ�Ĝü�ƋĘåƼ�ÏŅĵŞĬåƋå�ƵåĜčĘƋ�Ƶ±ƋÏĘåųŸ�ŞųŅčų±ĵţ��ĜƋƼ�Ņü�kDŽ�ÚŅåŸ�Ņýåų�ƵåĜčĘƋ�Ƶ±ƋÏĘåųŸ�ŞųŅčų±ĵ�ƋŅ�åĵŞĬŅƼååŸØ�ÆƚƋ�ÚŅåŸ�ĹŅƋ�pay for cost of program or food.

b. �±ƋĜŸĀåŸ��e���ƚĬåŸũ�cŅØ�ÆåϱƚŸå�ųåčŸ�ųåŧƚĜųå��ĜƋƼ�Ņü�kDŽ�ƋŅ�ޱƼ�üŅų�ÏŅŸƋ�Ņü�ŞųŅčų±ĵţ�BŅƵåƴåųØ�not required to pay for cost of food.

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

9

©2014 WellnessRebates, LLC. All Rights Reserved.

Key Themes in Final Wellness Regs:

1. 8ĬåƻĜÆĜĬĜƋƼ�ƋŅ�Ů)ĹÏŅƚų±čå�FĹĹŅƴ±ƋĜŅĹŰě�kĹĬƼ�ŸƋ±ĹÚ±ųÚ�ĜŸ�Ů�屟ŅűÆĬåĹåŸŸŰ a. Examples:

i. No established standards for “reasonable” design or alternative standards

1. �ĘŅƚčĘ�ÆåŸƋěŞų±ÏƋĜÏåŸ�±ĹÚ�ÏĬĜĹĜϱĬ�čƚĜÚåĬĜĹåŸ�ÚåĀĹåÚ�ÆƼ�±ÏÏųåÚĜƋåÚ�� � �� � � � � � � Ņųč±ĹĜDŽ±ƋĜŅĹŸ�Ůĵ±Ƽ�ĜĹÏų屟å�ĬĜĩåĬĜĘŅŅÚ�Ņü�ŸƚÏÏ域�±ĹÚ�±ųå�åĹÏŅƚų±čåÚŰ ii. cŅ�ŸŞåÏĜĀÏ�ųƚĬåŸ�ŅĹ�±ŞŞŅųƋĜŅĹĵåĹƋ�Ņü�ųåƵ±ųÚ�±ĵŅĹč�ü±ĵĜĬƼ�ĵåĵÆåųŸ 1.�a±ƻ�ĜŸ�ƐLjxĂLjŢ�Ņü�ƋŅƋ±Ĭ�ŞĬ±Ĺ�ÏŅŸƋ iii. kU�ƋŅ�ƚŸå�ŞåűĬƋƼ�Ņų�ųåƵ±ųÚ iv. kU�ƋŅ�ʱƴå�ĵŅųå�ü±ƴŅų±ÆĬå�ųƚĬåŸ�üŅų�ƋĘŅŸå�ƵĜƋĘ�±ÚƴåųŸå�Ęå±ĬƋĘ�ü±ÏƋŅųŸ�ŠÆƚƋ�ĹŅƋ�ƋĘå�ŅƋĘåų�� way around)

v. No limitation on which health conditions can be targeted with wellness programs

vi. No required incentive payment structure (other than must be paid in applicable year).

vii. cŅ�ŸŞåÏĜĀÏ�ƋƼŞå�Ņü�ĵåÚĜϱĬ�ŞųŅü域ĜŅűĬ�ųåŧƚĜųåÚ�ƋŅ�åƴ±Ĭƚ±Ƌå�ƵåĬĬĹ域�ŸƋ±ĹÚ±ųÚŸ� (example: doctor vs nurse)

viii. cŅ�ųåŧƚĜųåĵåĹƋ�üŅų�ŸŞåÏĜĀÏ�ĵåÚĜϱĬ�ŞųŅü域ĜŅűĬ�ĜĹƴŅĬƴåĵåĹƋ�ĜĹ�ƵåĬĬĹ域�ŞųŅčų±ĵ b.����ñ�ĵŅųå�čƚĜÚ±ĹÏå�ƋŅ�ÏŅĵåţ�aŅŸƋ�ƵĜĬĬ�ŞųŅƱÆĬƼ�ÏŅĹÏåųĹ�ÚåĀĹĜƋĜŅĹ�Ņü�ų屟ŅűÆĬåĹ域ţ

2. RAS rules are meant to protect those with medical conditions and encourage progress towards

health goals

a. Avoid discrimination by ensuring that, in all types of wellness programs, every participant

should be able to receive the full amount of any reward or incentive, regardless of health factor

bţ�{ųŅčų±ĵ�ĵƚŸƋ�ÏŅĹƋĜĹƚå�ƋŅ�Ņýåų��e�ŸØ�Ƽå±ų�±üƋåų�Ƽå±ųØ�åƴåĹ�Ĝü�åĵŞĬŅƼåå�ÏŅĹƋĜĹƚ±ĬĬƼ�ü±ĜĬŸ�ƋŅ�ĵååƋ�� goal

i. �ĵŅĩĜĹč�Ï域±ƋĜŅĹØ�ƵåĜčĘƋ�ĬŅŸŸ�ĜŸ�ʱųÚţ��å±ÚĜĹ域�üŅų�ÏʱĹčå�ÚĜýåųŸţ��åĬĬĹ域�ŞųŅčų±ĵ�� can experiment and should continue to provide support.

3. �ŅŸƋ��ĘĜüƋĜĹč�üŅų�ƵåĬĬĹ域�ĜŸ�kU�ÆåϱƚŸå�čŅ±Ĭ�ĜŸ�ƋŅ�ŞųŅĵŅƋå�Ęå±ĬƋĘ a. RAS requirement ensures that unhealthy are always given opportunity to earn reward

i. �ĘŅŸå�ƵĘŅ�Ÿ±ƋĜŸüƼ��e��åýåÏƋĜƴåĬƼ�ŸƚÆŸĜÚĜDŽåÚ�ÆƼ�åƴåųƼŅĹå�ĜĹ�ųĜŸĩ�ŞŅŅĬ�ŠƋĘŅŸå�ƵĘŅ�ĵååƋ�� goals, fail to meet goals, choose not to participate in program)

b. Ů�Ęå�ųåƵ±ųÚ�±ŸŸŅÏĜ±ƋåÚ�ƵĜƋĘ�ƋĘå�ƵåĬĬĹ域�ŞųŅčų±ĵ�ĜŸ�±Ĺ�ĜĹÏåĹƋĜƴå�ƋŅ�åĹÏŅƚų±čå�ĜĹÚĜƴĜÚƚ±ĬŸ�� to meet health standards associated with better or improved health, which in turn is associated

� � � ƵĜƋĘ�ĬŅƵåų�Ęå±ĬƋĘ�ϱųå�ÏŅŸƋŸţ�Fü�ƋĘå�ųåƵ±ųÚŸ�±ųå�åýåÏƋĜƴåØ�Ęå±ĬƋĘ�ϱųå�ÏŅŸƋŸ�ƵĜĬĬ�Æå�ųåÚƚÏåÚ��� as an individual’s health improves. Some of these lower health care costs could translate into

� � � ĬŅƵåų�ŞųåĵĜƚĵŸ�ޱĜÚ�ÆƼ�åĵŞĬŅƼåųŸ�±ĹÚ�åĵŞĬŅƼååŸØ�ƵĘĜÏĘ�ÏŅƚĬÚ�ŅýŸåƋ�ŸŅĵå�Ņü�ƋĘå�Ƌų±ĹŸüåųŸţ��� � � �Ņ�ƋĘå�åƻƋåĹƋ�Ĭ±ųčåų�ųåƵ±ųÚŸ�±ųå�åýåÏƋĜƴå�±Ƌ�ĜĵŞųŅƴĜĹč�Ęå±ĬƋĘ�±ĹÚ�ĬŅƵåųĜĹč�ÏŅŸƋŸØ�ƋĘåŸå�ĀűĬ�� � � ųåčƚĬ±ƋĜŅĹŸ�ƵĜĬĬ�ŞųŅÚƚÏå�ĵŅųå�ÆåĹåĀƋŸ�ƋʱĹ�ƋĘå�ÏƚųųåĹƋ�ųåŧƚĜųåĵåĹƋŸţŰ

�Xk�Fc:��Bk�:B��

A

QUIZ I & II – ANSWERS

QUIZ I: 1) participatory2) health contingent3) health contingent4) participatory

QUIZ II: 1) outcome-based2) activity only3) outcome-based4) outcome-based5) activity only

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

10

©2014 WellnessRebates, LLC. All Rights Reserved.

Notes

Questions for WellnessRebates

wellnessrebates

WELLNESS & THE ACA: IT’S NOT AS BAD AS YOU FEAR!

11

©2014 WellnessRebates, LLC. All Rights Reserved.

WellnessRebates™©2014 WellnessRebates LLC

CONTACT USinfo@wellnessrebates.com888.208.2788

VISIT OUR WEBSITEWellnessRebates.com

CONNECT WITH USfacebook.com/WellnessRebatestwitter.com/wellnessrebates