Employer-Sponsored Health Coverage

My employer offers a workplace wellness program that increases premiums for employees who can’t meet certain health targets, such as normal weight or blood pressure. Is this allowed?

Yes, as long as your employer workplace wellness program meets certain requirements, it can increase your premium by as much as 30 percent of the cost of the health plan if you don’t participate or meet required health targets. (Or, if one of the health targets involves tobacco use, the penalty can be as much as 50 percent of the cost of the health plan.) Some of the key requirements include:

  • The health plan must offer you a reasonable alternative way to avoid the penalty (for example, it might require that you participate in an exercise program, or it might require you to meet a less stringent target level for the required health measures)
  • If you are unable to meet the health targets due to a medical reason, the health plan must offer you an alternative way to avoid the penalty that is medically appropriate for you
  • The health plan must give you at least one chance every year to be re-evaluated

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.