Changing Rules for Workplace Wellness Programs: Implications for Sensitive Health Conditions

Issue Brief
  1. Normally under federal law, group health plans cannot vary premiums based on participants’ health status, but the Affordable Care Act (ACA) permitted such incentives within workplace wellness programs that meet other standards.

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  2. Under this requirement, for example, it would be permissible for the health plan’s wellness program to be offered to employees but not family members, or to full-time but not part-time employees.

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  3. This includes “programs to help employees stop smoking”, “programs to help employees lose weight”, “Other lifestyle or behavioral coaching”, such as health education classes stress management or substance abuse.  See 2016 Employer Health Benefit Survey.

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  4. However, incentives can be offered for a spouse to submit information about his/her past or current health status.  Under GINA, the definition of genetic information includes information about the current and past health status of a family member, including a spouse.

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  5. See for example, J. Stuber et al, “Stigma, Prejudice, Discrimination, and Health,” Social Science and Medicine, August, 2008.  See also, J. Ablon, “Stigmatized Health Conditions,” Social Science and Medicine, January 1981.  D. Quinn and S. Chaudoir, “Living with a Concealable Stigmatized Identity: The Impact of Anticipated Stigma, Centrality, Salience, and Cultural Stigma on Psychological Distress and Health,” Journal of Personal Social Psychology, October 2009.

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  6. Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.

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