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ACA Wellness Program Update

The Workplace Wellness Programs included in the ACA are part of a national strategy to improve wellness and combat chronic disease. The Act supports workplace wellness programs and allows employers to increase rewards for taking part and apply penalties for opting out.

The final ACA regulations identify three types of wellness programs:   

1. Participation Based: This type does not require the employee to make any behavior changes. For example, attending a nutrition class.

2. Activity Based: This type rewards ongoing behavior, even if there are no measurable results. For example, keeping a diet log or walking daily.

3. Result Based: This type rewards specific results. For example, reduced cholesterol or weight loss.

Some key points include:

  • The reward cannot exceed 30% of the total cost of healthcare, but another 20% is available for smoking cessation.
  • The program must be designed to promote health or prevent disease.
  • Wellness programs must not discriminate. It must be offered to all employees and offer alternatives for those who cannot reasonably take part.

Also, according to the Health Insurance Portability and Accountability Act (HIPPA), additional restrictions now apply to workplace wellness programs. To qualify for rewards, an employer must be able to prove their wellness program is, as the new law phrases it, “reasonably designed to promote health or prevent disease; has a reasonable chance of improving the health of, or preventing disease in, participating individuals; is not overly burdensome; is not a subterfuge for discriminating based on a health factor; and is not highly suspect in the method chosen to promote health or prevent disease.”

How Professional Staff Management Can Help

We offer wellness incentive programs through our Master Health plan coverage with Humana. If you have questions, please contact us.

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