The document provides guidance on final wellness regulations, including definitions of different types of wellness programs (participatory, activity-only, outcome-based) and answers to frequently asked questions. Key points include:
- Participatory programs do not require individuals to meet a standard related to a health factor to obtain a reward. Activity-only and outcome-based programs are considered health-contingent.
- For health-contingent programs, the full reward must be provided to individuals who meet an alternative standard within the same plan year. Rewards generally should not be provided in the year after they are earned.
- Wellness programs can include components that are participatory as well as activity-only
The document provides answers to frequently asked questions about final wellness regulations. It defines different types of wellness programs such as participatory, activity-only, and outcome-based programs. It addresses questions about timing of incentive awards, reasonable alternatives, calculating incentives, and applicability of incentives to new hires. Key points covered include that incentives must generally be awarded in the year standards are met, incentives are based on full employee coverage costs, and new hires can receive prorated incentives for the time enrolled. The document clarifies various aspects of implementing compliant wellness programs under final regulations.
Bill King's Vistage Presentation Healthcare ReformDouglasMcQueen
The document provides an overview of how the Affordable Care Act affects health plans and employers. It discusses provisions for grandfathered and new plans, including required coverage of preventive care and adult children up to age 26. It also outlines new regulations and taxes such as prohibitions on lifetime limits, requirements to offer coverage to full-time employees or pay penalties, and a 40% tax on high-cost plans.
Medicare Rule Review: Overview of Secondary Payersbenefitexpress
Learn how the Medicare Secondary Payer Rules impact an employer’s health and welfare plans. This covers which employers are subject, what employers can do to comply, and the penalties that can be imposed for noncompliance.
The document provides an overview of key provisions and implementation timeline of the Affordable Health Choices Act. Some highlights include:
- Insurance market reforms like ending rescissions and pre-existing condition exclusions begin in 2010.
- Improved benefits like dependent coverage up to age 26, prevention coverage without cost sharing, and a temporary high risk pool also start in 2010.
- Medicare and Medicaid improvements such as filling the donut hole and primary care pay parity in Medicaid phase in between 2010-2019.
- Public health programs around community health centers, prevention, and the health workforce expand in 2010.
The document discusses how the Affordable Care Act amended HIPAA to allow employers to offer premium discounts of up to 30% to employees who participate in wellness programs. It provides an overview of how HIPAA regulates wellness programs and premium discounts. For a program to be HIPAA compliant, it must meet 5 requirements - the reward cannot exceed 30% of the cost of single coverage, it must be reasonably designed to promote health, it must allow yearly opportunities to qualify, and it must offer reasonable alternatives for individuals who cannot meet the standard due to a medical condition. The document also discusses how wellness programs intersect with the ADA and age discrimination laws.
The document provides an overview of the Affordable Care Act (ACA) and its implementation in South Carolina. Some key points:
- The ACA requires most Americans to have health insurance or pay a penalty. It also prohibits denying coverage due to preexisting conditions and prohibits charging sick individuals higher premiums.
- South Carolina has a federally-facilitated health insurance marketplace for individuals and small businesses. Health plans must cover essential health benefits.
- Beginning in 2014, there is no annual or lifetime limits on coverage, no preexisting condition exclusions, guaranteed issue of policies, and limits on out-of-pocket costs. However, grandfathered plans are exempt from some provisions.
-
How To Make Wellness Programs Work For Consumersjpwlinkedin
This document discusses concerns with certain wellness program designs that tie health insurance costs and incentives to health outcomes. It may jeopardize access to affordable coverage for those with greater health risks. The Affordable Care Act changes wellness programs by increasing the maximum incentive to 30% of premiums. Regulations are needed to ensure wellness programs do not undermine the ACA's affordability provisions and consumer protections. Strengthening alternatives and waivers from outcome requirements can better protect consumers.
The document provides answers to frequently asked questions about final wellness regulations. It defines different types of wellness programs such as participatory, activity-only, and outcome-based programs. It addresses questions about timing of incentive awards, reasonable alternatives, calculating incentives, and applicability of incentives to new hires. Key points covered include that incentives must generally be awarded in the year standards are met, incentives are based on full employee coverage costs, and new hires can receive prorated incentives for the time enrolled. The document clarifies various aspects of implementing compliant wellness programs under final regulations.
Bill King's Vistage Presentation Healthcare ReformDouglasMcQueen
The document provides an overview of how the Affordable Care Act affects health plans and employers. It discusses provisions for grandfathered and new plans, including required coverage of preventive care and adult children up to age 26. It also outlines new regulations and taxes such as prohibitions on lifetime limits, requirements to offer coverage to full-time employees or pay penalties, and a 40% tax on high-cost plans.
Medicare Rule Review: Overview of Secondary Payersbenefitexpress
Learn how the Medicare Secondary Payer Rules impact an employer’s health and welfare plans. This covers which employers are subject, what employers can do to comply, and the penalties that can be imposed for noncompliance.
The document provides an overview of key provisions and implementation timeline of the Affordable Health Choices Act. Some highlights include:
- Insurance market reforms like ending rescissions and pre-existing condition exclusions begin in 2010.
- Improved benefits like dependent coverage up to age 26, prevention coverage without cost sharing, and a temporary high risk pool also start in 2010.
- Medicare and Medicaid improvements such as filling the donut hole and primary care pay parity in Medicaid phase in between 2010-2019.
- Public health programs around community health centers, prevention, and the health workforce expand in 2010.
The document discusses how the Affordable Care Act amended HIPAA to allow employers to offer premium discounts of up to 30% to employees who participate in wellness programs. It provides an overview of how HIPAA regulates wellness programs and premium discounts. For a program to be HIPAA compliant, it must meet 5 requirements - the reward cannot exceed 30% of the cost of single coverage, it must be reasonably designed to promote health, it must allow yearly opportunities to qualify, and it must offer reasonable alternatives for individuals who cannot meet the standard due to a medical condition. The document also discusses how wellness programs intersect with the ADA and age discrimination laws.
The document provides an overview of the Affordable Care Act (ACA) and its implementation in South Carolina. Some key points:
- The ACA requires most Americans to have health insurance or pay a penalty. It also prohibits denying coverage due to preexisting conditions and prohibits charging sick individuals higher premiums.
- South Carolina has a federally-facilitated health insurance marketplace for individuals and small businesses. Health plans must cover essential health benefits.
- Beginning in 2014, there is no annual or lifetime limits on coverage, no preexisting condition exclusions, guaranteed issue of policies, and limits on out-of-pocket costs. However, grandfathered plans are exempt from some provisions.
-
How To Make Wellness Programs Work For Consumersjpwlinkedin
This document discusses concerns with certain wellness program designs that tie health insurance costs and incentives to health outcomes. It may jeopardize access to affordable coverage for those with greater health risks. The Affordable Care Act changes wellness programs by increasing the maximum incentive to 30% of premiums. Regulations are needed to ensure wellness programs do not undermine the ACA's affordability provisions and consumer protections. Strengthening alternatives and waivers from outcome requirements can better protect consumers.
News Flash: September 16, 2013 – Federal Regulators Have Been Busy; Two New D...Annette Wright, GBA, GBDS
Federal regulators issued two new developments related to health care reform: 1) A model notice of HIPAA privacy practices with versions for health plans and providers to use; and 2) New guidance on applying health care reform to HRAs, health FSAs, and other arrangements. The new guidance indicates stand-alone HRAs are no longer viable unless integrated with group health coverage by meeting restrictive conditions. It also addresses health FSAs, EAPs, and employer-paid premium arrangements. The guidance is intended to coordinate previous rules and fill gaps, clarifying that tax-favored employer health coverage must comply with reform laws.
Supreme Courts Ppaca Ruling What Does It Mean For Plan SponsorsJames Kane
The document discusses the Supreme Court ruling on the Affordable Care Act and its impact on employers. Key points include:
1) The individual mandate requires individuals to have health coverage starting in 2014 or pay a penalty.
2) Starting in 2014, employers with over 50 full-time employees must offer affordable health coverage to those employees or face penalties.
3) Employers need to determine if they have over 50 full-time employees to be in compliance. Planning should begin well in advance of the 2014 deadline.
4) Employers must carefully weigh the cost of compliance versus the cost of penalties, while also considering tax advantages and workforce expectations.
This presentation highlights the changes required of small businesses to maintain compliance with Health Care Reform regulations. Cathy Harbison, director of operations for employee benefits at Neace Lukens, served as the expert speaker to explain upcoming changes for 2011 – 2014, and the implications for businesses with less than 50 employees.
[Medi]Caring About Delayed Retirement: A Closer Look at Medicare Strategybenefitexpress
With questions about millennials dominating our conversations about benefits, it’s easy to forget that the work force is growing from both ends. Baby boomers are delaying retirement while millennials (and even Gen Z) start their careers. As boomers become Medicare eligible, many remain on their employer’s coverage, whether or not that’s the best choice for them. Get the tools you need to:
- Navigate paying claims
- Understand how Medicare interacts with COBRA and other healthcare
- Lead eligible employees through their options
- Craft a compliant notification strategy
Improve the Health of Your Wellness ProgramInfinisource
The document discusses regulations around wellness programs under the Affordable Care Act. It summarizes that there are two categories of wellness programs - participatory programs that don't require health standards and health-contingent programs that do. For 2014, the maximum reward for health-contingent programs is 30% of health plan costs or 50% if related to tobacco cessation. Employers have leeway in establishing reasonable alternatives. The document recommends employers consider using wellness rewards to fund health flexible spending accounts or health reimbursement arrangements to increase the value for employees and comply with nondiscrimination rules.
Wellness Workout: Cardio for Your Compliance Reviewbenefitexpress
In the race for top talent, wellness plans are no longer an option, they are a necessity. Like medical insurance and a 401(k), basic wellness benefits are expected by your prospective employees.
Learn how to structure a new plan or reform your existing program to optimize employee engagement and regulatory compliance.
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
Health Reform Bulletin – IRS PronouncementsCBIZ, Inc.
Information on 1) Cafeteria Plan Status Change Events, 2) Employment Status Change Proposals to Employer Shared Responsibility Rules, 3) Increase in PCOR Fees, and Final Excepted Benefit Regulations. Recently, the Internal Revenue Service (IRS) released three pronouncements relating to the Affordable Care Act (ACA). In addition, final regulations have been issued relating to certain excepted health benefits.
Although many key reforms of the Affordable Care Act (ACA) are effective for 2014, additional reforms will become effective in 2015 for employers sponsoring group health plans. For 2015, the most significant ACA change is the shared responsibility penalty for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy. This Legislative Brief provides a health care reform checklist for 2015.
Health Reform Alert - Implementation Guidance FAQsCBIZ, Inc.
The ACA’s governing agencies (Labor, HHS and IRS) have issued their 18th set of implementation FAQs, further defining certain aspects of the Affordable Care Act, as well as how the law coordinates with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Following are highlights of this guidance.
Learn more at www.cbiz.com
Created by WEA Trust Vice President & General Counsel Vaughn Vance, this presentation helps explain to employers the changing health insurance marketplace. You'll learn about new fees and taxes, plan restrictions and employer obligations under health care reform.
The document discusses new limits on out-of-pocket maximums for health plans under the Affordable Care Act. Starting in 2014, group health plans cannot have out-of-pocket maximums exceeding $6,350 for individual coverage or $12,700 for family coverage. However, guidance from regulators on how exactly plans must comply is still limited. The document outlines some of the key questions employers have around complying with these new limits and what expenses count toward the maximum. It also discusses some exceptions for grandfathered plans, excepted benefits, and retiree-only plans.
Health Care Reform -- 2016 Compliance Checklistntoscano50
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Additional reforms take effect in 2016 for employers sponsoring group health plans. To prepare for 2016, employers should review upcoming requirements and develop a compliance strategy.
To prepare for open enrollment, health plan sponsors should become familiar with the legal changes affecting plans for the 2014 plan year. In addition, health plan sponsors should make sure that open enrollment packages include certain participant notices.
Compliance Bulletin - New York Enacts Paid Family Leave LawNicholas Toscano
On April 4, 2016, New York Governor Andrew Cuomo signed a bill that will require employers to provide paid family leave benefits to eligible employees as part of the state’s disability insurance program.
Paid family leave benefits will be phased in over a four-year period, beginning Jan. 1, 2018. When the law is fully implemented in 2021, employees may be eligible for up to 12 weeks of paid family leave.
Health Care Reform Legislative Brief
2013 Compliance Checklist
In light of the Supreme Court's June 28, 2012, decision to uphold the health care reform law, or Affordable Care Act (ACA), employers must continue to comply with ACA mandates that are currently in effect.
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted in 2010. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Certain changes to some ACA requirements take effect in 2017 for employers sponsoring group health plans, such as increased dollar limits. To prepare for 2017, employers should review upcoming requirements and develop a compliance strategy.
The document provides a timeline for key provisions of the Affordable Care Act (ACA) being implemented between 2010-2014. Some 2010 provisions included requiring plans to cover adult children up to age 26, prohibiting pre-existing condition exclusions for children, covering preventive care with no cost sharing, and establishing a high-risk pool. An improved claims/appeals process and rebates for the Medicare Part D "donut hole" also took effect in 2010. Future provisions will expand insurance coverage and reforms through 2014.
The document summarizes final regulations issued by the Department of Treasury on employer shared responsibility provisions under the Affordable Care Act. Key points include:
1) Employers with 50-99 employees have an additional year, until 2016, before they must comply with the employer mandate.
2) Transition rules for 2015 include requiring coverage for at least 70% of full-time employees rather than 95%, and not requiring dependent coverage.
3) Prior transition rules are retained, including the use of measurement periods to determine variable hour employee status and non-calendar year plan effective dates.
4) Guidance is provided on determining full-time status for certain occupations like volunteers, educators, seasonal workers and student employees
The US Supreme Court ruled that closely-held for-profit corporations cannot be compelled to provide contraceptive coverage that violates the religious beliefs of company owners under the Religious Freedom Restoration Act. The ruling applies to the four contraceptive methods that Hobby Lobby objected to providing in their health plans. While the ruling does not exempt companies from all insurance mandates that conflict with religious beliefs, it does allow closely-held companies to avoid paying for contraceptive services they have religious objections to. The federal government is expected to expand existing exemptions for non-profits to comply with the ruling, but more litigation around the Affordable Care Act is still anticipated.
News Flash: September 16, 2013 – Federal Regulators Have Been Busy; Two New D...Annette Wright, GBA, GBDS
Federal regulators issued two new developments related to health care reform: 1) A model notice of HIPAA privacy practices with versions for health plans and providers to use; and 2) New guidance on applying health care reform to HRAs, health FSAs, and other arrangements. The new guidance indicates stand-alone HRAs are no longer viable unless integrated with group health coverage by meeting restrictive conditions. It also addresses health FSAs, EAPs, and employer-paid premium arrangements. The guidance is intended to coordinate previous rules and fill gaps, clarifying that tax-favored employer health coverage must comply with reform laws.
Supreme Courts Ppaca Ruling What Does It Mean For Plan SponsorsJames Kane
The document discusses the Supreme Court ruling on the Affordable Care Act and its impact on employers. Key points include:
1) The individual mandate requires individuals to have health coverage starting in 2014 or pay a penalty.
2) Starting in 2014, employers with over 50 full-time employees must offer affordable health coverage to those employees or face penalties.
3) Employers need to determine if they have over 50 full-time employees to be in compliance. Planning should begin well in advance of the 2014 deadline.
4) Employers must carefully weigh the cost of compliance versus the cost of penalties, while also considering tax advantages and workforce expectations.
This presentation highlights the changes required of small businesses to maintain compliance with Health Care Reform regulations. Cathy Harbison, director of operations for employee benefits at Neace Lukens, served as the expert speaker to explain upcoming changes for 2011 – 2014, and the implications for businesses with less than 50 employees.
[Medi]Caring About Delayed Retirement: A Closer Look at Medicare Strategybenefitexpress
With questions about millennials dominating our conversations about benefits, it’s easy to forget that the work force is growing from both ends. Baby boomers are delaying retirement while millennials (and even Gen Z) start their careers. As boomers become Medicare eligible, many remain on their employer’s coverage, whether or not that’s the best choice for them. Get the tools you need to:
- Navigate paying claims
- Understand how Medicare interacts with COBRA and other healthcare
- Lead eligible employees through their options
- Craft a compliant notification strategy
Improve the Health of Your Wellness ProgramInfinisource
The document discusses regulations around wellness programs under the Affordable Care Act. It summarizes that there are two categories of wellness programs - participatory programs that don't require health standards and health-contingent programs that do. For 2014, the maximum reward for health-contingent programs is 30% of health plan costs or 50% if related to tobacco cessation. Employers have leeway in establishing reasonable alternatives. The document recommends employers consider using wellness rewards to fund health flexible spending accounts or health reimbursement arrangements to increase the value for employees and comply with nondiscrimination rules.
Wellness Workout: Cardio for Your Compliance Reviewbenefitexpress
In the race for top talent, wellness plans are no longer an option, they are a necessity. Like medical insurance and a 401(k), basic wellness benefits are expected by your prospective employees.
Learn how to structure a new plan or reform your existing program to optimize employee engagement and regulatory compliance.
This presentation reviews: what information must be protected, what policies and procedures need to be in place, what disclosures have to be given to employees, what agreements have to be in place for business associates, and what breach procedures have to be followed.
Health Reform Bulletin – IRS PronouncementsCBIZ, Inc.
Information on 1) Cafeteria Plan Status Change Events, 2) Employment Status Change Proposals to Employer Shared Responsibility Rules, 3) Increase in PCOR Fees, and Final Excepted Benefit Regulations. Recently, the Internal Revenue Service (IRS) released three pronouncements relating to the Affordable Care Act (ACA). In addition, final regulations have been issued relating to certain excepted health benefits.
Although many key reforms of the Affordable Care Act (ACA) are effective for 2014, additional reforms will become effective in 2015 for employers sponsoring group health plans. For 2015, the most significant ACA change is the shared responsibility penalty for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy. This Legislative Brief provides a health care reform checklist for 2015.
Health Reform Alert - Implementation Guidance FAQsCBIZ, Inc.
The ACA’s governing agencies (Labor, HHS and IRS) have issued their 18th set of implementation FAQs, further defining certain aspects of the Affordable Care Act, as well as how the law coordinates with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Following are highlights of this guidance.
Learn more at www.cbiz.com
Created by WEA Trust Vice President & General Counsel Vaughn Vance, this presentation helps explain to employers the changing health insurance marketplace. You'll learn about new fees and taxes, plan restrictions and employer obligations under health care reform.
The document discusses new limits on out-of-pocket maximums for health plans under the Affordable Care Act. Starting in 2014, group health plans cannot have out-of-pocket maximums exceeding $6,350 for individual coverage or $12,700 for family coverage. However, guidance from regulators on how exactly plans must comply is still limited. The document outlines some of the key questions employers have around complying with these new limits and what expenses count toward the maximum. It also discusses some exceptions for grandfathered plans, excepted benefits, and retiree-only plans.
Health Care Reform -- 2016 Compliance Checklistntoscano50
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Additional reforms take effect in 2016 for employers sponsoring group health plans. To prepare for 2016, employers should review upcoming requirements and develop a compliance strategy.
To prepare for open enrollment, health plan sponsors should become familiar with the legal changes affecting plans for the 2014 plan year. In addition, health plan sponsors should make sure that open enrollment packages include certain participant notices.
Compliance Bulletin - New York Enacts Paid Family Leave LawNicholas Toscano
On April 4, 2016, New York Governor Andrew Cuomo signed a bill that will require employers to provide paid family leave benefits to eligible employees as part of the state’s disability insurance program.
Paid family leave benefits will be phased in over a four-year period, beginning Jan. 1, 2018. When the law is fully implemented in 2021, employees may be eligible for up to 12 weeks of paid family leave.
Health Care Reform Legislative Brief
2013 Compliance Checklist
In light of the Supreme Court's June 28, 2012, decision to uphold the health care reform law, or Affordable Care Act (ACA), employers must continue to comply with ACA mandates that are currently in effect.
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted in 2010. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Certain changes to some ACA requirements take effect in 2017 for employers sponsoring group health plans, such as increased dollar limits. To prepare for 2017, employers should review upcoming requirements and develop a compliance strategy.
The document provides a timeline for key provisions of the Affordable Care Act (ACA) being implemented between 2010-2014. Some 2010 provisions included requiring plans to cover adult children up to age 26, prohibiting pre-existing condition exclusions for children, covering preventive care with no cost sharing, and establishing a high-risk pool. An improved claims/appeals process and rebates for the Medicare Part D "donut hole" also took effect in 2010. Future provisions will expand insurance coverage and reforms through 2014.
The document summarizes final regulations issued by the Department of Treasury on employer shared responsibility provisions under the Affordable Care Act. Key points include:
1) Employers with 50-99 employees have an additional year, until 2016, before they must comply with the employer mandate.
2) Transition rules for 2015 include requiring coverage for at least 70% of full-time employees rather than 95%, and not requiring dependent coverage.
3) Prior transition rules are retained, including the use of measurement periods to determine variable hour employee status and non-calendar year plan effective dates.
4) Guidance is provided on determining full-time status for certain occupations like volunteers, educators, seasonal workers and student employees
The US Supreme Court ruled that closely-held for-profit corporations cannot be compelled to provide contraceptive coverage that violates the religious beliefs of company owners under the Religious Freedom Restoration Act. The ruling applies to the four contraceptive methods that Hobby Lobby objected to providing in their health plans. While the ruling does not exempt companies from all insurance mandates that conflict with religious beliefs, it does allow closely-held companies to avoid paying for contraceptive services they have religious objections to. The federal government is expected to expand existing exemptions for non-profits to comply with the ruling, but more litigation around the Affordable Care Act is still anticipated.
The document provides tips for employers to avoid an unannounced Department of Labor wage and hour investigation. It discusses ensuring fair compensation practices, understanding regulations, training managers, analyzing state vs federal laws, paying past overtime due, following child labor laws, properly classifying interns, responding to internal complaints, seeking DOL compliance assistance, and conducting a self-audit. It also summarizes several articles on using HR metrics to communicate value to an organization, the Early Retiree Reinsurance Program funds being exhausted, how HHS will define essential health benefits, Maryland allowing same-sex marriage, and San Francisco's healthcare reporting requirements.
News Flash February 21 2014 - Final Regulations on PPACA 90-Day Waiting Peri...Annette Wright, GBA, GBDS
The Departments of Treasury, Labor and Health and Human Services issued final regulations implementing the 90-day waiting period provisions under the PPACA. The final regulations adopt rules from the proposed regulations in 2013 and introduce new guidance. Under the rules, a group health plan cannot apply a waiting period that exceeds 90 days. The regulations also allow employers to use an orientation period of up to one month to evaluate new employees before the waiting period begins. The final regulations are effective for plan years beginning on or after January 1, 2015.
This document summarizes questions and answers about HIPAA privacy requirements for employee benefit plans. It addresses whether insured plans need to send a Notice of Privacy Practices, how to determine the date a plan became subject to HIPAA, which benefits are subject to HIPAA privacy rules, how to fill in template forms correctly, and how covered entities must distribute the Notice of Privacy Practices. Key details include that insured plans may qualify for a compliance shortcut and not need to send notices, and that covered entities must post notices on their website and deliver notices to individuals by mail or email.
The document summarizes regulations issued by HHS regarding the transitional reinsurance program established by the Affordable Care Act. The reinsurance program requires health insurers and self-insured group health plans to make contributions in order to help stabilize premiums for individual market policies from 2014-2016. Contribution amounts are based on a national per capita rate, and the total contributions collected will be $12 billion in 2014, $8 billion in 2015, and $5 billion in 2016. Certain limited benefit plans and government-sponsored plans are exempt from making reinsurance contributions.
The IRS has released draft guidance on electronic filing of Affordable Care Act reporting forms for 2014 and beyond. The guidance outlines the two-step process that issuers and transmitters must follow to register with the IRS e-Services system and obtain a Transmitter Control Code to file ACA Information Returns electronically using the Affordable Care Act Information Returns system. Only XML file formats are accepted, with a 100MB limit per transmission. Employers with 250 or more employees should begin preparing now to file electronically by the first quarter 2016 deadline.
The document summarizes information about the transitional reinsurance fee that employers with self-insured health plans must pay, including:
1) The fee is $44 per covered individual for 2015 and must be paid in full by January 15, 2016 or in two installments of $33 by January 15, 2016 and $11 by November 15, 2016.
2) Employers must submit enrollment counts using the pay.gov website by November 16, 2015.
3) The Centers for Medicare and Medicaid Services will hold information sessions by phone and email through November 16th to assist employers with submitting enrollment counts and fees.
The document is a survey report from Willis that summarizes the results of their 2015 Benefits Benchmarking Survey. Some key findings include:
- PPO/POS plans are offered by 87% of employers and are the most prevalent plan type. HSA-eligible CDHPs are the second most offered at 47%.
- On average, employers offer 3 or fewer medical plan options. The majority (85%) of employers offer 3 plans or fewer.
- Regionally, HMO/EPO plans are significantly more prevalent in the West, offered by 51% of employers in that region compared to 13-42% elsewhere.
The proposed regulations clarify rules around workplace wellness programs under the Affordable Care Act and HIPAA. They allow rewards of up to 30% of health coverage costs (50% for tobacco cessation programs) and require programs to be reasonably designed to promote health and available to all employees through alternative standards or waiver for those unable to meet initial standards due to health factors. Programs must provide notice of alternative means to earn rewards. Participatory programs like fitness center memberships need not comply if they do not discriminate based on health status.
Keeping Up to Date With Wellness Regulations 2015benefitexpress
Learn about the latest developments in wellness programs. A review of EOCC's legal action against wellness programs will be covered and steps to avoid legal action will be discussed.
Offering Wellness Programs After Final Regulationsbenefitexpress
This webinar reviews the requirement that an employer must meet under the new final HIPAA regulations. It will also cover other compliance issues dealing with taxation, ERISA and ADA.
Keeping Up to Date With Wellness Regulationsbenefitexpress
This document discusses compliance issues related to wellness programs under HIPAA, GINA, and ADA. It provides an overview of the requirements for wellness programs under HIPAA, including the rules for health-contingent and participation-only programs. Health-contingent programs must meet five requirements: the reward cannot exceed 20-30% of coverage costs; the program must be reasonably designed to promote health; individuals must have an opportunity to qualify at least annually; the reward must be available to all similarly situated individuals; and alternative standards must be disclosed. The document outlines these requirements and provides examples.
Health Contingent Wellness Programs Draft PowerPoint with BH EditsDresden Maddox
The document outlines plans for developing an outcomes-based wellness program at HarbinStrong. It defines outcomes-based programs as incentivizing employees for meeting specific health goals. The purpose is to encourage healthy behaviors and reduce healthcare costs. Methodology discusses researching legislation, other programs, and health benchmarks. Examples show participation rates increased over 95% and insurance claims decreased by 1-3% with incentives for meeting biometric goals. Implementation should consider phasing in requirements and tracking progress.
Starting Your Corporate Wellness Program: Ideas and Compliance for HR Prosbenefitexpress
Review all of the requirements that an employer must follow to offer a valid wellness plan. In addition, learn the new rules released by the EEOC for wellness programs under ADA and GINA.
Does your wellness plan need a compliance check?Polsinelli PC
Wellness programs are designed to promote employee health and fitness in hopes of also lowering a company's costs in providing medical benefits. W. Andrew Douglass, Shareholder and chair of Polsinelli's Employee Benefits and Executive Compensation practice, was joined by Associate Anne Prenner Schmidt to discuss:
*General overview of wellness programs, including health screening features, premium incentives, and other common plan designs
*Compliance issues for wellness programs under the *Americans with Disabilities Act (ADA), Affordable Care Act (ACA), and other federal laws
*Discussion of recent lawsuits brought by the EEOC against employers, and expectations for the EEOC's future regulations for wellness programs
*Action items for in-house counsel, as well as human resources and financial professionals in navigating the uncertainties and risks in offering wellness programs to their employees.
Accountable Care Act Employer Compliance.sharedoc.Roberta Winter
This document provides a roadmap for employers to comply with the employer shared responsibility provisions of the Affordable Care Act (ACA). It explains that employers with 50 or more full-time equivalent employees must offer affordable health insurance that provides minimum value to full-time employees and their dependents or pay a penalty. It outlines the process for determining the number of eligible employees and calculating any penalties owed based on two tests: a W-2 wage test or look-back measurement method. The document also provides guidance on the criteria a health plan must meet to avoid penalties, including coverage and benefit thresholds.
Health Reform: Interim Guidance on Expatriate Plans; Updates on ACA Reportin...CBIZ, Inc.
This Health Care Reform Bulletin provides information on the following topics:
a. Interim Guidance on Expatriate Health Coverage
b. Updates on Section 6055/6056 Reporting
i. Revised and Increased Reporting Penalties
ii. E-filing requirements for Employers
c. Final Rules: Preventive Services
d. Reminder on PCOR Fees and Transitional Reinsurance
i. Checklist for PCOR and Transitional Reinsurance Fee
The document discusses outcome-based wellness incentives introduced by the Patient Protection and Affordable Care Act (PPACA). It provides the following key points:
1) The PPACA allows employers to tie financial incentives for employees to meeting certain health outcomes like biometrics, with incentives up to 30% of individual health plan costs. This approach aims to increase personal responsibility for health.
2) Safeway led the push for these rules, seeing success lowering health risks and costs through their program tying incentives to outcomes since 2009.
3) While controversial, outcome-based programs have potential to significantly improve population health and lower costs over time by incentivizing reduction of chronic diseases driven by behaviors.
4)
The document discusses nondiscrimination in health care plans based on smoking under federal and New Jersey law. Currently, federal law allows health plans to offer rewards up to 20% of coverage costs to nonsmokers, rising to 30% in 2014. New Jersey law prohibits employment discrimination against smokers but allows health plans to require higher contributions from smokers. Federal law preempts state laws regarding employer-sponsored health plans. Federal regulations permit wellness programs that require health standards if they offer reasonable alternatives and limit rewards to 20% of coverage costs (rising to 30% in 2014).
How to Administer Wellness Programs in Today's Regulatory Environmentbenefitexpress
Are you struggling to make sense of the recent legislative updates surrounding employer sponsored wellness programs? Perhaps you are trying to decide whether to continue with current wellness plans, modify your plans without guidance from the EEOC, postpone new wellness programs or discontinue them all together.
It’s a complicated landscape ripe with several options for “next steps” for employees and plan sponsors of wellness plans in 2019 — with perhaps the biggest barrier of all being that employers cannot measure the risk of wellness plans at this time.
To help guide you through this maze of options, watch our one-hour webinar on-demand to learn what rules remain after the EEOC’s regulations were found invalid and what rules have to be met in 2019 in order to offer a valid wellness program.
How to administer wellness programs in today's regulatory environment
This webinar covers:
Requirements under HIPAA
Requirements under the Internal Revenue Code
Requirements under ERISA
Requirements under GINA
Requirements under ADA
Requirements under ACA
News Flash December 23, 2013—Agency Release Proposed Rules on Excepted BenefitsAnnette Wright, GBA, GBDS
The agencies charged with implementing the Affordable Care Act issued proposed rules that would amend the definition of excepted benefits, which are exempt from certain requirements of federal health care laws. The proposed rules would affect dental and vision benefits, wraparound coverage, and employee assistance programs. Specifically, the rules would eliminate premium requirements for limited dental and vision benefits and treat certain wraparound plans and employee assistance programs as excepted benefits if they meet specified criteria, such as not being an integral part of the primary health plan or providing significant medical benefits. Public comments are invited on how to define terms like "significant medical benefits."
Workplace Wellness Programs & The Law: Your ACA, HIPAA and ERISA Compliance C...Snag
This document discusses workplace wellness programs and related legal compliance. It defines a culture of wellness as one that encourages employees to actively engage in self-care and chronic disease management. It outlines different types of wellness programs, including participatory programs that reimburse gym memberships or reward health assessments, and health-contingent programs that offer rewards for meeting specific health standards or outcomes. The document provides an overview of legal compliance standards for these programs under the Affordable Care Act, HIPAA, ERISA, and other relevant laws.
59828 employee benefits compliance checklist for small employers 021312Jerry Whitaker CIC,CRIS
This document provides a compliance checklist for various federal employee benefit laws applicable to small employers with 50 or fewer employees. It lists the key laws, including whether they apply to small employers or have exceptions. For those that apply, it summarizes the main requirements and any associated notices that must be provided to employees. Some major laws discussed include the Affordable Care Act, COBRA, HIPAA, FMLA, ERISA and COBRA. The document is intended to help small employers understand and comply with federal benefit plan regulations.
This document discusses the implications of the Mental Health Parity and Addiction Equity Act of 2008 for employer-provided health plans. It addresses whether moving mental health benefits to an employee assistance program (EAP) would avoid the Act's requirements and analyzes different types of excepted benefits that are not subject to the Act. The document also outlines potential cost exemptions and opt-out provisions for certain self-funded government plans.
The document discusses the key principles of effective wellness programs, known as Wellness 2.0 programs. It outlines six defining principles: 1) strategic planning to evaluate population health and set goals; 2) incentives tied to health benefits and outcomes; 3) building a culture of wellness; 4) engaging employees through technology and gamification; 5) promoting overall wellbeing, not just physical health; and 6) using metrics to measure impacts and results. The principles are meant to create sustainable and accountable wellness cultures that maximize success in improving employee health and reducing costs.
The Impact Of The Affordable Health Care Act On Fitness FacilitiesBryan K. O'Rourke
The Affordable Health Care Act Will Create Opportunities For Fitness Facilities To Deliver Services To Employers. Learn How In This Presentation Prepared By Graham Melstrand of ACE and Bryan O'Rourke of the Fitness Industry Technology Council.
Are you ready for the upcoming 2014 provisions of the new healthcare reform act? Do you know what the implications are to you as a small or midsize company?
Our webinar will help you become familiar with upcoming requirements under the Patient Protection and Affordable Care Act.
Expect to learn the following and more:
What is the Patient Protection and Affordable Care Act
How does an organization determine their 2014 cost to comply?
What should organizations be doing now to prepare?
Consumer-Centric Technology in Benefits AdministrationCraig Burma
This document discusses defined contribution (DC) health benefit plans, also known as "DC health plans". It examines the key features of DC health plans, including how employer contributions are determined and issues around employee choice and plan design innovations. The advantages and disadvantages of DC health plans for employers and employees are also assessed. While interest in DC health plans is growing due to rising healthcare costs and complexity, significant challenges around implementation remain. Widespread adoption of full DC health plans may depend on factors like unemployment levels and further healthcare cost increases.
This document summarizes key Social Security, Medicare, and retirement plan limits for 2017 and 2018. For Social Security, the wage base and maximum annual benefit increased slightly, as did annual retirement earnings limits. For Medicare, premiums and deductibles increased modestly. For retirement plans, the compensation limit and contribution limits increased, with the defined benefit plan limit rising to $220,000. Health savings account contribution and deductible/out-of-pocket expense limits also increased for individual and family coverage.
The document introduces The HR Trove, an online store providing HR products and expertise. The store offers around 100 basic products to start with areas like benefits, compensation, and employee development. Sample products include HR software, videos, surveys, guides, templates and reports covering topics such as benefits for different generations, compensation benchmarking, and employment policies. The HR Trove aims to be a one-stop shop matching the breadth of HR solutions and trusted expertise that clients expect from Willis Towers Watson.
The IRS issued a second notice regarding guidance on the Cadillac tax, set to take effect in 2018. The notice addresses issues such as who is liable for the tax, employer aggregation rules, determining the cost of coverage, and adjusting the dollar limits based on employee age and gender. The IRS is considering designating Form 720 as the method for paying the excise tax on a particular quarter of the calendar year. Comments on the notices are due by October 1, 2015, after which the IRS intends to issue proposed regulations.
The IRS released interim guidance on how certain provisions of the Affordable Care Act apply to expatriate health plans under the Expatriate Health Coverage Clarification Act of 2014. The guidance provides additional time for expatriate plans to modify their plans to meet exemption requirements under the new law. It also clarifies that the Patient-Centered Outcomes Research Institute fee does not apply to plans that cover qualified expatriates as defined by the act. The interim guidance applies to policies issued or renewed on or after July 1, 2015 and plan years starting on or after that date.
The Patient-Centered Outcomes Research Institute (PCORI) was created by the Affordable Care Act to promote research that compares the effectiveness of medical treatments. PCORI is funded by an annual fee paid by health insurers and sponsors of self-insured health plans. Plan sponsors must calculate the average number of lives covered and pay the PCORI fee of $2 per life for plan years ending before October 1, 2014 or $2.08 per life after on Form 720 by July 31 of the year following the plan year. Responsibility for paying the fee lies with the health insurer for fully insured plans and the plan sponsor for self-insured plans.
- The document discusses communications that some employers have received from the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) regarding Transitional Reinsurance Fee (TRF) payments for 2014. These communications were inadvertently sent to some employers even when the insurance company had submitted the payment.
- CMS has provided guidance for employers to respond to these communications by indicating whether their insurance company submitted the TRF payment on their behalf. If so, employers will need to contact their insurance company for details on the payment submission to provide CMS.
- The guidance aims to help CMS reconcile records by confirming whether TRF payments were made for covered employers and collecting additional information from insured employers where
The EEOC published proposed rules on how Title I of the ADA applies to employer wellness programs that are part of group health plans. The proposed rules provide guidance to employers on how wellness programs can comply with ADA and HIPAA provisions. For a wellness program to be considered voluntary under the proposed rules, employees cannot be required to participate, cannot be denied health coverage or benefits for non-participation, and employers cannot retaliate against employees. Employers must also provide a notice to employees about what medical information is collected and how it is used and kept private.
The document discusses IRS Notice 2015-16 regarding guidance on the excise tax on high-cost employer-sponsored health plans, also known as the "Cadillac tax". The Notice seeks comments on key issues related to implementing the tax. Willis is participating in an industry group response and provides a template letter for plan sponsors to submit their own comments to the IRS by May 15, 2015. The letter template is available on Willis' website.
The document summarizes a recent FAQ from the Department of Labor regarding the implementation of health care reform law. The FAQ provides an update on when final rules for the summary of benefits and coverage (SBC) and uniform glossary will be issued. According to the FAQ, final rules are intended to apply for plan years beginning on or after January 1, 2016, and the new SBC template and documents will be finalized by January 2016 and apply for plan years beginning on or after January 1, 2017. The proposed regulations would amend previous SBC regulations and templates to make them more user-friendly.
The document discusses the current status of the Patient Protection and Affordable Care Act (PPACA) five years after its enactment. It covers three key areas: regulatory guidance, legal challenges, and legislative efforts to amend or repeal the law. Regarding regulatory guidance, employers are waiting for rules on provisions like the excise tax on high-cost plans and nondiscrimination requirements for insured plans. There have been several legal challenges to PPACA, with the Supreme Court upholding the individual mandate but limiting expansion of Medicaid. Congress has unsuccessfully attempted to fully repeal PPACA but has considered some amendments. Overall, PPACA continues to significantly impact employers as they comply with its provisions.
The Supreme Court heard oral arguments in King v. Burwell, a case that will determine whether the Affordable Care Act allows tax subsidies for health insurance purchased through federal exchanges. A ruling for the plaintiffs could significantly impact employer penalties under the employer mandate by limiting penalties only to employees who receive subsidies through state exchanges, rather than federal exchanges used by many states. Employers should continue their compliance efforts and await the Supreme Court's ruling in late June before making any changes.
The Departments of Labor, Health and Human Services, and the Treasury issued a FAQ clarifying when supplemental coverage qualifies as an excepted benefit. According to the FAQ, only supplemental group health coverage that does not include essential health benefits may qualify. The Departments intend to propose regulations stating that supplemental coverage filling gaps in primary coverage categories will only qualify if the benefits are not essential health benefits in that state. Pending rulemaking, the Departments will not enforce against supplemental coverage of non-essential health benefits that complies with existing guidance.
The Department of Labor, Internal Revenue Service, and Equal Employment Opportunity Commission have released their semiannual regulatory agendas outlining new regulations for the coming year. In a change, most of the anticipated new rules do not focus on implementing provisions of the Affordable Care Act as they have for the past five years. The agendas include only a few exceptions and are otherwise modest in terms of new health plan regulations. This may provide an opportunity for employers to review their compliance efforts over the past five years and prepare for potential increased agency audits by documenting their actions. The summaries highlight some areas where new guidance is being developed, including updates to COBRA and preventive services notices, clarification of wellness programs under the ADA
The IRS released final forms and instructions for health care reform reporting in 2014 and 2015. Forms 1095-B and 1094-B are used by health insurers to report minimum essential coverage to individuals and the IRS. Forms 1095-C and 1094-C are used by applicable large employers to report offers of health coverage to employees and the IRS to determine employer shared responsibility penalties. While reporting is voluntary for 2014, it will be mandatory beginning in 2016. The final forms and related Q&As are now available on the IRS website.
News Flash January 27 2015 - Settled Law Changing _ Retiree Medical Benefits...Annette Wright, GBA, GBDS
The following article describes a new employee benefits development (Supreme Court decision could make it easier for employers to reduce union retiree health benefits).
News Flash January 20 2015 - Supreme Court Agrees to Address Same Sex MarriageAnnette Wright, GBA, GBDS
On January 16, 2015, the Supreme Court of the United States announced that it will take up the issue whether persons of the same gender have the right to marry under the U.S. Constitution.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
acne vulgaris -Mpharm (2nd semester) Cosmetics and cosmeceuticals
Final Wellness Regulation FAQ
1. Final Wellness Regulation
Frequently Asked Questions
The following FAQs address the final wellness rule. However, plan sponsors must remain mindful of other
laws and compliance with those requirements – for instance ADA, ADEA, GINA, etc.
Terminology
What is a Participatory wellness program? This type of wellness program either does not provide a
reward or does not include any conditions for obtaining a reward if those conditions are based on an
individual satisfying a standard that is related to a health factor. Examples of a “Participatory” plan
would be: 1) reimbursing employees for all of part of the cost of membership in a fitness center; 2) a
health risk assessment or biometric screening that does not base any part of the reward on the outcome
of the assessment/screening; 3) an annual physical, as long as no part of the reward is based upon the
outcome of the physical.
What is an Activity-Only wellness program? This is a type of a Health-Contingent wellness program (as
is the Outcome-Based program described below). Under an Activity-Only wellness program, an
individual is required to perform or complete an activity related to a health factor in order to obtain a
reward. The individual is not required to attain or maintain a specific health outcome. Examples of an
“Activity-Only” plan would be: 1) a walking, diet, or exercise program; and 2) a targeted educational
program based upon health needs determined through a health risk assessment. A reasonable
alternative standard must be offered if it is unreasonably difficult for the individual to satisfy or it is
medically inadvisable for the individual to attempt to satisfy the applicable wellness standard.
What is an Outcome-Based wellness program? This is the second type of Health-Contingent wellness
program. Under an Outcome-Based wellness program, an individual must attain or maintain a specific
health outcome in order to obtain a reward. Examples of an “Outcome-Based” plan would be: 1)
smoking cessation program; 2) weight-loss program; 3) cholesterol-lowering program. A reasonable
alternative standard must be offered to anyone who does not meet the initial standard based on a
measurement test or screening that is related to a health factor.
Timing of Incentive Awards
Question 1: May a plan sponsor offer a Health-Contingent (“Activity-Only” or “Outcome-Based”)
wellness program that allows individuals to earn/accumulate “wellness points” during one year and
then “cash in” those points for a lower premium over the next plan year?
2. Answer 1: The regulations are silent on this point. However, the preamble to the final regulations
specifically limits when a reward based upon meeting a “reasonable alternative standard” may be applied.
The preamble says:
First, in order to satisfy the requirement to provide a reasonable alternative standard,
the same, full reward must be available under a Health-Contingent wellness program
(whether an Activity-Only or Outcome-Based wellness program) to individuals who
qualify by satisfying a reasonable alternative standard as is provided to individuals who
qualify by satisfying the program’s otherwise applicable standard. Accordingly, while an
individual may take some time to request, establish, and satisfy a reasonable alternative
standard, the same, full reward must be provided to that individual as is provided to
individuals who meet the initial standard for that plan year. (For example, if a calendar
year plan offers a Health-Contingent wellness program with a premium discount and an
individual who qualifies for a reasonable alternative standard satisfies that alternative
on April 1, the plan or issuer must provide the premium discounts for January, February,
and March to that individual.) Plans and issuers have flexibility to determine how to
provide the portion of the reward corresponding to the period before an alternative was
satisfied (e.g., payment for the retroactive period or pro rata over the remainder of the
year) as long as the method is reasonable and the individual receives the full amount of
the reward. In some circumstances, an individual may not satisfy the reasonable
alternative standard until the end of the year. In such circumstances, the plan or issuer
may provide a retroactive payment of the reward for that year within a reasonable time
after the end of the year, but may not provide pro rata payments over the following
year (a year after the year to which the reward corresponds).
Though the preamble only addresses the timing of a reward based upon meeting the reasonable
alternative standard, it is presumed that the same timing requirements apply to the initial HealthContingent wellness standard, since the reasonable alternative standard (which is offered after an
individual cannot meet the initial wellness standard) would be the later of the initial standard and the
reasonable alternative standard.
Because of the manner in which the Departments of Labor, Treasury, and Health and Human Services
described the limits of the final regulation, they indicated that they generally did not intend for individuals
to receive a wellness reward in the year after credits were earned by virtue of the reasonable alternative
standard, and in no case was the reward (earned the prior year) to be spread out over the whole following
plan year.
Willis’ Recommendation: Many wellness administrators are offering a points-based program that
functions in opposition to the guidance within the preamble. Willis is recommending the most
conservative approach – that the reward be granted generally within the year that it is earned (except to
the extent that the individual meets the requirements at the end of the year, in which case the award is
paid out as soon as possible after the beginning of the new year). We recognize that many/most wellness
vendors are NOT administering their plans in this manner. Willis’ guidance is based upon the Preamble,
which is not regulatory law, but rather an explanation (written by the IRS, Department of Labor, and HHS)
regarding how they intended the regulations to apply. We believe that their comments within the
3. Preamble are important. If plan sponsors choose to take a more aggressive stance, or if wellness vendors
offer only a more aggressive plan administration of wellness rewards, then the ultimate decision about
how to proceed must rest with the plan sponsor.
While the regulations and the preamble are silent with regard to when the reward for the initial wellness
standard must be provided, we believe that it is best if the Health-Contingent wellness plan reward be
paid within the plan year that it is earned. The silence within the preamble and the regulation with regard
to Participatory wellness programs (for which a reasonable alternative standard is not offered) may also
lead some plan sponsors to believe that the same “plan year” restrictions do not apply to a wellness
reward for a Participatory wellness program, and that plan sponsors have much more freedom with
regard to providing rewards under a Participatory program. Without further guidance on this point, Willis
would not recommend this position.
Finally, there may be other ways to provide the same effect – such as funding a Health Reimbursement
Arrangement (“HRA”) with the wellness amount (subject to the nondiscrimination and PPACA mandates
tied to HRAs) or crediting an amount to the employer cafeteria plan that is fully usable at the beginning of
the year. The options are not specified in the regulations or the guidance as being permitted or
prohibited, so obtaining advice from the plan sponsor’s counsel is necessary.
Participatory Program Difference
Note – Willis does not necessarily feel that the “reward within the same plan year” timing restriction
applies to a Participatory wellness program. The preamble discusses the timing requirement in the section
of the preamble that describes the Health-Contingent programs. So, if the wellness program is strictly a
Participatory program (such as requiring a biometric screening during the year in order to receive a
discount in premiums the following year), Willis believes that the reward can be spread out over the next
year. An additional complication arises if the two types of wellness programs are combined (which is not
uncommon). For example, obtaining the biometric screening permits a discount of 5% and then based on
the outcome, there might be an additional discount. We believe that the wellness components could be
part of the same wellness plan and that it would be possible to apply the applicable wellness rules to each
separate component of the wellness plan (applying the Health-Contingent rules to the wellness
components which are Health-Contingent, and applying the Participatory rule to the wellness components
which are Participatory). An even more conservative standpoint would be to consider the whole wellness
plan to be subject to the Health-Contingent plan wellness requirements. There is no specific guidance that
would require one approach over the other.
Question 2: If we decide to offer a wellness program which offers individuals the accumulation of
points during one year and a wellness reward paid out through the following year, are we more likely to
be audited?
Answer 2: We are not currently aware of audits on this issue. Following this plan design will not
necessarily trigger an audit. However, an employee complaint may trigger an audit. Moreover, the
preamble does contain language that additional guidance will be promulgated by the agencies if they
determine that the rules are not being interpreted as they desire.
4. Willis’ Recommendation: Plan sponsors should seek legal counsel when determining how to offer a
wellness program.
Wellness Plan Design
Question 3: Is it possible for a wellness program to have components that are “Participatory” in
addition to other components which are either “Activity-Only” or “Outcome-Based” plan designs?
Answer 3: Yes. A wellness program may be made up of various components. Each component will be
subject to the wellness regulations which apply to that type of wellness component. For instance, if an
individual elects to go through biometric screening, then that screening will likely be a “Participatory”
benefit which is not required to comply with the rules associated with Health-Contingent based wellness
programs. If the plan sponsor’s wellness program also includes a smoking cessation program and a weight
management program, then those programs will be subject to the requirements which apply to “HealthContingent” wellness programs.
Willis’ Recommendation: Plan sponsors must consider each component of wellness programs and must
identify the component and thus determine which requirements apply to that component.
Question 4: At the beginning of the plan year, a plan sponsor announces an upcoming health risk
assessment and biometric screening and says that a particular score must be achieved. Later in the
year, the plan sponsor brings in a vendor to perform the health risk assessments and biometric
screening. If an employee does not achieve the desired score, the employee will pay a penalty which
does not exceed the wellness plan penalty limits. However, if the employee cannot meet the desired
score, the plan will accept a doctor’s waiver, and the employee will receive the wellness incentive. Does
this plan meet the wellness plan requirements?
Answer 4: Yes. This is an Outcome-Based wellness plan design. The plan sponsor offers a reasonable
alternative standard, and the full wellness reward is available to the employee once the reasonable
alternative standard is satisfied
Calculation of Wellness Incentive
Question 5: How is the wellness reward (or surcharge) calculated?
Answer 5: In 2014 the reward or surcharge must not be more than 30% (or 50% if the wellness program
prevents or reduces tobacco usage). This wellness reward or surcharge is based upon the full cost of the
employee-only coverage, not the employee’s portion of the coverage. If an employer offers a tobacco
cessation program and the premium for employee-only coverage is $250 per month, then the
5. reward/surcharge could be as much $125 per month discount (or surcharge). However, if the wellness
program is offered to family members enrolled in the plan, then the wellness discount/surcharge is
applied against the full cost of the coverage within which the family members are covered.
The wellness reward (or surcharge) can also impact cost sharing elements like copays, coinsurance, and
deductibles. If these costs are decreased or raised as part of the wellness program, then the combination
of all of the copay/coinsurance/deductible decreases or surcharges for Health-Contingent wellness plans
cannot exceed 30% (or 50% if the wellness program includes a tobacco cessation program).
Requiring Health Risk Assessment or Biometric Screening
Question 6: May a plan sponsor require that individuals meet the requirements of the HealthContingent wellness plan by a particular point during the plan year (prior to the last day of the plan
year) in order to receive the wellness incentive?
Answer 6: No. Plan sponsors may not establish an arbitrary deadline (other than requiring individuals to
comply with the terms of the wellness plan or the reasonable alternative standard) by the end of the year.
It is permissible for an individual to meet the requirements of the plan by the end of the plan year and
then receive a pay-out of the award within a reasonable time after the beginning of the next plan year. An
employer may presumably offer wellness courses (for instance, a smoking cessation course) at several
intervals during the year, and the employer could mandate that if an employee waits until the end of the
year in order to satisfy the wellness standard, then the employee must complete the multi-meeting course
by the end of the plan year, and therefore, it is likely that an employer could impose a time requirement
on the employee that allows completion of the program by the end of the plan year.
Willis’ Recommendation: A plan sponsor “best practice” would be for employees to be given the freedom
to comply with the wellness plan design requirements at any time during the plan year as long as the
requirements are met on/before the last day of the plan year. Plan sponsors should seek legal counsel in
evaluating plan designs.
Question 7: May a plan sponsor require an individual’s participation in a health risk assessment in order
to receive any benefits under the plan?
Answer 7: The best practice answer is “No.” Compliance with the HIPAA wellness requirements does not
exempt the plan from compliance with other federal laws. Conditioning the provision of benefits on the
completion of a health risk assessment removes the voluntary nature of a “Participatory” benefit may
cause a violation of the Americans with Disabilities Act (ADA) because the reward (coverage under the
plan) cannot be conditioned upon the health risk assessment. Staff of the Equal Employment
Opportunities Commission (EEOC) has stated in informal guidance that they would view that mandate as a
6. violation of the ADA. If a health risk assessment is offered, the plan sponsor must be careful that it does
not condition the incentive on the outcome of the health risk assessment.
However, that informal guidance is not part of the formal guidance and has never been advanced beyond
an informal “Q&A” format. Members of other departments have opined differently, and there is some
opinion that the EEOC would not seek to enforce that provision of the ADA – particularly in light of the
other formal guidance from the Employee Benefits Security Administration. Nevertheless, employers
should be cautious before deciding to make the completion of the health risk assessment mandatory.
Question 8: May a plan sponsor require an individual’s participation in a health risk assessment in order
to receive BETTER benefits (for instance the “gold” benefits plan as opposed to the “bronze” benefits
plan)?
Answer 8: Maybe. This would be a Participatory wellness program, so the offer of better coverage must
simply be available to all similarly-situated individuals. However, the plan sponsor cannot condition the
provision of better benefits based upon the outcome of the health risk assessment. There is no official
guidance on this issue, and the concern is compliance with the ADA. Whether the EEOC would see this
plan design as impermissible under the ADA is unknown. This is a “gray” area of the law.
Question 9: The plan sponsor requires that a health risk assessment and a biometric screening must be
performed in order for the employee to receive a lower deductible. This same incentive is offered to
retirees and to COBRA qualified beneficiaries. Is this permissible?
Answer 9: Yes. The plan sponsor has the ability to offer wellness incentives to groups/individuals beyond
those who are “similarly situated” individuals. Retirees would not be “similarly situated;” however,
COBRA qualified beneficiaries (those receiving COBRA continuation coverage) would be “similarly
situated” and should receive lower deductible if they comply with the wellness plan terms. The plan may
choose to voluntarily treat retirees as “similarly situated” and therefore give them the ability to earn
wellness incentives. If the plan chooses to extend wellness incentives to retirees, the plan is not required
to pay for the retiree health screenings; instead, the plan could pass onto the retirees, the costs associated
with the health risk assessment and the biometric screening.
Apportionment of Wellness Incentive
Question 10: If an employer sponsors a Health-Contingent plan design, and if both the employee and
the employee’s spouse may participate in the wellness program, but the spouse chooses not to
participate (or meet the reasonable alternative standard), may the plan withhold the incentive reward
from the employee, who DOES meet the wellness requirements?
7. Answer 10: No. Health-Contingent plans must offer each eligible individual the opportunity to achieve
the reward at least once per year. If the plan allows the employee’s spouse to negate the employee’s
right to the wellness reward, then the employee has not been given the opportunity to qualify for the
reward on an annual basis. The final rule notes that if the wellness plan design is a Health-Contingent
plan, then the plan sponsor must fairly divide/”apportion” the reward between the participating and nonparticipating spouses. Plan sponsors have freedom with regard to how to apportion the reward, but
under a Health-Contingent plan, one spouse may not negate the other spouse’s ability to receive a
wellness reward.
NOTE: This rule about reasonable apportionment between family members does not exist under a
“Participatory” wellness plan design, so under such a plan, presumably, it is permissible to establish an
“all-or-nothing” plan design.
Wellness Incentive as Cash, Gift Cards, Goods
Question 11: If the reward for complying with the wellness program is a gift card or some other reward
which does not affect the co-pays, coinsurance, deductible, premiums, or employer contributions to an
account-based plan (like a flexible spending account), then is the wellness program subject to the HIPAA
wellness rule?
Answer 11: No. This simply means that the plan sponsor would choose not to avail itself of the
protections afforded by the HIPAA wellness rules (and the plan sponsor would not be subject to the
additional requirements under the wellness rule). Additionally, from a tax perspective, cash or a gift card
or goods awarded to a participant would be taxable to the participant.
Question 12: A plan sponsor offers an extra vacation day to all employees who complete a biometric
screening. Is this permissible?
Answer 12: Yes, we believe that it is permissible to do this. However, because the reward does not affect
the plan in any way (doesn’t reduce premiums or deductibles and doesn’t trigger a contribution to
account-based benefits), the plan is not subject to the requirements under the HIPAA Wellness rules. This
example of a plan issuing a vacation day as incentive is not addressed within the wellness rule, but the
wellness rule seems to be limited to benefits which are subject to HIPAA. Since a vacation day is not
subject to HIPAA, then the award of a vacation would not appear to trigger the application of the HIPAA
wellness rules.
8. New Hires and Wellness Incentives
Question 13: Must a plan sponsor award the whole Health-Contingent wellness incentive to a new hire
(hired any time after the beginning of the year) who meets the wellness standard?
Answer 13: The regulation is silent on this subject, but there is nothing within either the preamble or the
final rule to indicate that a new hire must receive the whole incentive award. Rather, we believe that it is
reasonable for the plan sponsor to award a pro rata portion of the full wellness incentive at the point that
the new hire meets the wellness standard. For instance, if the employee is hired in the 10th month of the
plan year, upon meeting the wellness standard, the new hire would be eligible for two months’ worth of
the wellness incentive.
Wellness Plans and “Pay or Play” Affordability
Question 14: When calculating the “affordability” of the medical plan for “Pay or Play” purposes, is the
discounted premium contribution under the wellness plan used?
Answer 14: Generally, no. In most cases, the “affordability” of the plan is determined by assuming that
each employee fails to satisfy the wellness requirements (and therefore each employee pays a higher
premium). However, if the wellness program includes a tobacco cessation program, then the affordability
of the plan is determined assuming that each employee MEETS the wellness requirements (and therefore
each employee pays a lower premium).
The information in this publication is not intended as legal or tax advice and has been prepared solely
for informational purposes. You may wish to consult your attorney or tax adviser regarding issues raised
in this publication.