Employee Health Screening

Compliance with health insurance portability and accountability act (HIPAA) non-discrimination rules is a large challenge for health promotion programs.  The old rules were unclear about which incentives passed muster.

That’s all changed, with the rules established earlier this year by the DOL and United States  Treasury Department.  The rules themselves haven’t changed, but they’ve been clarified. Here is what you need to know -

â..Participation incentives’ are fine

As long as you structure incentives as rewards for wellness participation, the new rules provide a lot of freedom. All of these are fine under HIPAA -

o  reimbursing all or a portion of the cost of health club membership

o  financial rewards for undergoing health risk assessments so long as the reward is based on participation rather than test results

o  encouraging preventive care by waiving co-pays or deductibles for these services (i.e., well-baby visits or prenatal care)

o  reimbursing personnel for the cost of use of tobacco-cessation programs without regard to the result, and

o  offering rewards tied to workforce attending a monthly health education seminar or working with a health Coach.

Conditional rewards OK ifâ..

But what if you want to make the reward conditional on participants meeting specific health goals? Example – Staff Members who achieve a cholesterol count under 200 get a 20 percent reduction in the cost of their medical plan contributions pending results of an annual cholesterol test.

The feds say it’s OK under health insurance portability and accountability act (HIPAA) to do this, too, but your plan must meet five additional requirements -

o  The reward can’t exceed 20% of the cost of employee-only (or, if you allow dependents to participate, employee-plus-dependent) coverage under your health plan.

o  The standards must be reasonable (e.g., you can’t limit rewards to folks who can run a marathon).  The rewards also can’t be used as a backhanded way to negatively single out certain personnel (e.g., rewards for all non-diabetics).

o  Participants must’ve the opportunity to qualify for the reward at least once per year (e.g., a smoker who fails to quit this year gets another chance next year).

o  Rewards must be available to all “similarly situated individuals.” In other words, you can’t make a company-paid weight control program available to certain staff members but not others.

If, for medical reasons, it’s unreasonably challenging for a personal to satisfy conditions that are otherwise reasonable, you must offer an alternative. Example –  A pregnant worker may not be able to meet certain standards, so you must offer her an alternative.

Negative incentives violate health insurance portability and accountability act (HIPAA)

So what’s not permitted under HIPAA’s non-discrimination rules? Anything that punishes people  for their medical conditions or health risks.

The rules prohibit employers from charging different premiums, contributions, co-pays or deductibles based on personal health factors like obesity or smoking. Nevertheless, it’s OK to reimburse these expenditures based on someone’s participation in your wellness program, without regard to success.

In addition, the feds have added an important new non-discrimination rule – Employers’ health care programs can’t deny benefits for treatment of injuries resulting from a health condition, even when the condition wasn’t diagnosed before the injury.

For example, some heath programs have a “suicide exclusion” that denies payment for treating self-inflicted wounds from a suicide attempt. Now let’s suppose the worker suffers from clinical depression. Even when the depression was undiagnosed before the suicide attempt, it’s illegal for your plan to deny benefits to this worker.