The Department of Labor recently released a checklist to help determine whether a group health plan's wellness program is in compliance with regulations that became effective recently.
The department created the checklist in response to questions about regulations the department published in 2006. The final regulations cover the nondiscrimination provisions of the Health Insurance Portability and Accountability Act (HIPAA) and include guidance on the implementation of wellness programs.
The regulations apply to group health plans and group health insurance issuers on the first day of the plan year beginning on or after July 1, 2007. Accordingly, for calendar year plans, the new regulations began to apply on January 1, 2008.
The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment, or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs.
The final regulations specify that wellness programs that condition a reward on an individual satisfying a standard related to a health factor must meet five requirements to comply with HIPAA's nondiscrimination rules.
Health factors include: health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), and disability.
The checklist offers guidance on what types of health promotion or disease prevention programs offered by a group health plan must comply with the department's final wellness program regulations and a guidance on how a plan determines whether such a program is in compliance with the regulations.
The department included the checklist in Field Assistance Bulletin No. 2008-02.