If you are a fit, active person, your employer’s wellness plan might be one reason you chose to work for them. However, if you have pre-existing health conditions, a busy family life, or a commitment to your own health and fitness routines, you might worry that a mandated wellness plan could be a burden—or worse, could get you fired. Regardless of what your employer has told you about participating in a wellness plan, there are limits on what they can and cannot require. It’s important that you understand your rights so that you can protect them.
What Kind of Wellness Plan Does Your Employer Offer?
The Affordable Care Act (ACA) and HIPAA prohibit group health plans from charging different premiums, co-pays, or deductibles to individuals who are “similarly situated.” In other words, your employer’s health insurance provider can’t charge different amounts to different employees based on health or other factors. Companies can, however, offer incentives and rewards to employees for participating in a wellness program. Companies might offer one of two types of wellness programs in conjunction with their group health insurance plan:
Participatory wellness program.
This kind of program is generally just a nice perk. There might be no reward or incentive offered at all, or if there is, it is not based on achieving a standard related to a health outcome. These programs include benefits such as reimbursing the cost of a gym membership or smoking cessation program, or offering a reward for participating in diagnostic testing or no-cost health seminars, regardless of the outcomes. In other words, you are rewarded just for participating and are not required to achieve a certain health outcome.
Health-contingent wellness program.
These programs require participants to satisfy an activity requirement or health outcome in order to be rewarded. The company cannot require participation or penalize those who do not participate, but they can offer discounts on health insurance premiums, co-pays, or deductibles to those who do participate and meet certain standards. These types of plans must adhere to strict rules issued by the ACA and HIPAA, including allowing individuals the opportunity to qualify at least once a year, limiting the reward to 30 percent or less of the full cost of coverage, accommodating disabilities, and clearly disclosing all of the terms and alternatives.
The bottom line is that, while companies can offer incentives to get employees to participate in a wellness plan, they cannot require it, nor can they punish those who choose not to participate.
What If a Wellness Plan Is Discriminatory?
The wellness plans employers offer must provide equal opportunities for all employees to achieve the reward. The ACA spells out very clear guidelines for accommodating employees with health concerns or disabilities that prevent them from achieving the health or activity standard required by a health-contingent wellness plan. The program can seek physician verification when an employee requests an accommodation, but the alternative standard or activity must be reasonable. Examples of steps the plan could take to meet the “reasonable” requirement include:
- Helping the employee find alternative educational programs
- Ensuring that the time commitment is reasonable
- Paying membership or participation fees for diet programs
- Offering another alternative if the individual’s personal physician states that the offered alternative is not medically appropriate for them
If you feel that you are being discriminated against in your lack of access to rewards offered by a health-contingent wellness plan, it might be worth your time to talk to a New Jersey anti-discrimination attorney.
Know Your Rights to Protect Your Rights
Most employers who offer wellness programs connected to group health insurance plans rely on third-party providers to handle the details, so they might not be aware of the ACA rules they are expected to follow or even what they should or should not tell employees about participating in the program. That does not excuse them from being accountable, however, if they violate your rights. Contact New Jersey employment lawyer Frank Steinberg to learn more about your options for getting equal access to health insurance discounts from your employer.