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Wellness program final rule requires lower premiums for participants

May 31, 2013 | By
Tools

Insurers must offer members with employer-sponsored health insurance significantly lower premiums for participating in wellness programs--regardless of whether they actually improve their health.

In a final rule issued Wednesday by the U.S. Departments of Health & Human Services, Treasury and Labor, employer-based wellness programs must be structured so every participating employee can "receive the full amount of any reward or incentive, regardless of any health factor."

Employers can now reward workers when they participate in wellness programs by decreasing their premiums by up to 30 percent. That premium reduction could reach as much as 50 percent for programs aimed at preventing or reducing smoking. Alternatively, the rule allows insurers to penalize members with higher premiums if they don't participate in a wellness program, allowing for example, smokers to pay 50 percent more for their premiums than non-smoking members.

But some healthcare advocates said the penalties could be unfair. "It could be a way of charging someone in less-than-ideal health more for insurance, which is something healthcare reform is trying to move away from," Kathleen Stoll, director of health policy at Families USA, a non-profit group that supports healthcare reform, told Reuters. And since the rule doesn't require insurers provide scientific evidence that the wellness programs actually work, employees could be penalized for not participating in programs that aren't even effective, she added.

The rule, which is mostly in line with the proposed version released last year, also outlines how the agencies will determine if a wellness program meets the criteria of a so-called reasonable design, including whether it has a reasonable chance of improving the participants' health or preventing disease. The programs also can't be overly burdensome, a strategy for discrimination, or use "highly suspect" methods to promote health or prevent disease.

To learn more:
- here's the rule
- read the Reuters article

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