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HIPAA - Wellness Programs

by The Human Equation, Inc. on 8/21/2008
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Our organization plans to implement a program that reimburses employees the cost of participating in a smoking cessation program. Although we hope all employees who participate in the program will succeed, their status in our group health plan will not be affected if they continue to smoke. Will this plan violate the Health Insurance Portability and Accountability Act's nondiscrimination provisions?

No. The nondiscrimination provisions of the Health Insurance Portability and Accountability Act (HIPAA) generally prohibit group health plans from charging similarly situated individuals different premium or contribution amounts, or imposing different deductible, copayment, or other cost sharing requirements, because of an individual's health factors. Health factors include health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability. However, there is an exception to HIPAA's nondiscrimination provisions that allows group health plans to offer wellness programs, which are designed to promote health or prevent disease.

Under this exception, if none of the conditions for obtaining the reward under a wellness program are based on whether an individual satisfies a standard related to a health factor, and if participation in the program is made available to all similarly situated individuals, then the program will not violate HIPAA's nondiscrimination provisions. A diagnostic testing program that provides a reward for employee participation rather than the outcome qualifies for the exception because the condition for receiving the reward is not based on a health factor. Similarly, in this situation, the employees receive the reward, whether they succeed in quitting smoking or not. Thus, the condition for receiving the reward is not based on a health factor. Accordingly, this reimbursement program will not violate HIPAA's nondiscrimination provisions.

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Categories: 2008

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