A growing number of employers are embracing wellness programs in hopes of controlling their health care costs, but there’s plenty of opportunity to get into legal trouble.
Until more definitive rules are written, “there’s just not much out there” to help employers steer clear of potential litigation, Eleanor Thompson, an attorney at McCarter and English in Philadelphia, told attendees at a session at the Risk & Insurance Management Society conference Monday in Denver.
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She was joined by Carol Staubach, the principal of a health risk management consultancy, also based in Philadelphia, who pointed out employees can bring claims alleging discrimination, violation of medical privacy, breach of collective bargaining agreements and more.
Good intentions are fine, but wellness programs, they said, must comply with the Patient Protection and Affordable Care Act, the Americans with Disabilities Act, IRS Code 105(h), the Public Health Service Act, the Genetic Information Nondiscrimination Act and other state and federal laws.
There are two types of wellness programs PPACA mentions: activity-only programs and those that are outcome-based.
Employers struggling to reign in swelling health care costs have experimented with both for years, though the health care reform law has helped to fuel their growth.
Both come with their own set of rules, some which could be considered common sense, others more specific, if not esoteric. For example, in an outcomes-based program, a plan must pay any diet program membership fees but not for the food.
Employers can sometimes find themselves in trouble over the amount of the reward they include in their wellness programs, Thompson said.