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Life Health > Health Insurance

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By Staff Writer

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The Employee Benefits Security Administration has come out with guidance aimed at sponsors of employer-sponsored health promotion and disease prevention initiatives.

EBSA, an arm of the U.S. Labor Department, published the guidance, given in Field Assistance Bulletin Number 2008-02, in response to questions about which programs must comply with the department’s new wellness program regulations and how sponsors can tell whether a program is complying.

For plans with plan years that correspond to the ordinary calendar year, the new regulations began to apply Jan. 1, Daniel Maguire, EBSA health plan standards director, writes in the bulletin.

When deciding whether a program is a “wellness program” for purposes of complying with the new regulations, “ignore the labels,” Maguire writes. “Wellness programs can be called many things. Other common names include: disease management programs, smoking cessation programs and case management programs.”

But Maguire notes that the vehicle an employer uses to deliver all of the many different types of wellness programs affects compliance: The new EBSA regulations apply only to wellness programs offered through group health plans.

“If the employer operates the wellness program as an employment policy separate from the group health plan, the program may be covered by other laws, but it is not subject to the group health plan rules discussed here,” Maguire writes.

Wellness programs subject to the new regulations can offer plan members incentives to participate, but the value of the incentives cannot exceed 20% of the cost of the health coverage, Maguire writes.

Any rewards also must be available to all similarly situated individuals, and there must be a way for individuals to obtain the reward if medical conditions keep them from satisfying the standard for the reward or if it is medically inadvisable for the individual to attempt to satisfy the standard, he writes.

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