As part of health care reform, wellness programs that provide incentives based on specific health metrics (i.e. BMI, cholesterol, etc.) will be required to offer “reasonable alternative standards” to employees who do not meet the initial requirements. The final rules also increase the maximum dollar amount of rewards or surcharges to 30% of the total premium cost of health care coverage (up from 20%) and up to 50% for incentives tied to smoking prevention or reduction programs. *
Reasonable alternative standards: Employees must be given an opportunity to qualify for the reward if they fail to meet the initial standard. For example, an employer could charge higher premium contributions to employees or spouses who have a Body Mass Index (BMI) in excess of 30. Therefore, the employer would have to offer an alternative means for participants to avoid the surcharge.
BWS is committed to improving the health of our wellness participants. We strongly believe that our appeals programs already provide reasonable alternatives for participants to achieve their wellness goals. BWS will continue to work closely with you and your organization to ensure that your wellness program is in compliance with new health reform regulations.
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*Please note that there are still only minimal requirements for programs that are based on participation. These programs must be made available to all similarly situated individuals, but otherwise have no design limitations. Also, note that the reward cannot exceed the applicable percentage of the total cost of employee-only coverage under the plan, taking into account both employer and employee contributions toward the cost of coverage for the benefit package under which the employee is (or the employee and the dependents are) receiving coverage. If, in addition to employees, any class of dependents (such as spouse, or spouses and dependent children) may participate in the health-contingent wellness program, the reward cannot exceed the applicable percentage of the total cost of the coverage in which the employee and any dependents are enrolled (such as family coverage or employee-plus-one coverage).