Promote Wellness But Respect Privacy

–The total reward that may be given to an individual is limited. A top award with a value equal to 10% to 20% of the total cost of employee-only coverage may be appropriate.

–The program must be reasonably designed to promote good health or prevent disease for individuals in the program.

–The reward must be available to all similarly situated individuals. More specifically, the program must give any individual for whom it is unreasonably difficult due to a medical condition to meet the wellness program standard (or for whom it is medically inadvisable to attempt to meet the wellness program standard) an opportunity to satisfy a reasonable alternative standard.

–All plan materials describing the terms of the program must disclose the availability of a reasonable alternative standard.

Programs such as smoking cessation classes, weight-loss programs, gym memberships and walking programs can be considered true wellness programs if all members are provided with reasonable alternative standards.

Employees may experience medical and physical limitations that prevent them from being able to achieve the wellness goal successfully. For instance, smoking is considered nicotine addiction–as powerful as any other drug addiction. This addiction may be an illness the member cannot control. Therefore, in order for a wellness program to be considered bona fide under HIPAA, it should reward participants for successful completion of a task, such as taking a class, even if the participants fail to meet the goal of improving their health.

In addition, HIPAA limits required documentation stating the employer may ask only for receipts for class completion or gym membership. They cannot request signed affidavits from course instructors or logs of a member’s progress. These programs are based largely on the ‘honor’ system.

Though the HIPAA regulations may seem to dilute the effectiveness of a given wellness program, it is important that the rewards are equally available to all employees willing to participate in the task. This may actually bolster participation and create awareness among those individuals who may not have otherwise participated.

The first step in changing behavior is changing employees’ way of thinking. If only one member attains the goal of quitting smoking, losing weight or lowering blood pressure, then the health plan possibly has avoided claim costs associated with a heart attack, stroke, diabetes or other long-term health problem. The intangible benefit, of course, is that a healthier work force often results in lower absenteeism and increased employee morale.