Federal agencies just issued new final rules for contingency-based wellness program goals under health reform.
If employers offer to give a reward (such as discounted health insurance premiums) to workers who accomplish some kind of biometric goal (a contingency standard), then employers must have a standing “reasonable alternative” to the contingency-based standard, government officials told reporters on a May 29 call.
Employees should not need to get a note from their physician to be excused from the employer’s contingency-based wellness goal: at least one alternative should be available to anybody for any reason, regardless of the requestor’s health status, a senior official from the U.S. Department of Labor’s Employee Benefits Security Administration said.
Note from Physician Can Set Wellness Goal
The final rule then states that a worker who feels that the employer’s contingency-based standard doesn’t work for him or her can see a physician to work out a biometric goal that the employee can use to replace the employer’s contingency-based standard.
Employers with contingency-based incentive programs will have to provide notice of their right to an alternative standard for gaining the employer’s reward, but the notice also has to inform workers of their right to get a second opinion for an alternative standard that the employer will adopt if possible.
The officials said the rule was not going to force undue changes on wellness programs, in spite of the new requirements on reasonable alternatives and physician recommendations.
The officials said their agencies (in addition to DOL, Treasury and Health and Human Services) decided against requiring wellness standards be evidence-based (which would have been an extra burden on wellness program sponsors), opting instead to give employers the flexibility of setting wellness goals, against a “reasonableness” standard.
The officials stressed that the final rules, issuing from the health reform statutes of 2010, are in no way a safe harbor for nondiscrimination rules being enforced by other agencies, such as the EEOC, which continues to impose uncertainty on wellness programs incentives and rewards.
For more information on health reform’s impacts on wellness programs, see The New Health Reform Law — What Employers Need to Know.