A Legal Roadmap for Wellness Programs

Health insurance ranks among the top costs for an employer. Wellness programs can lead to lower premiums and impact a company’s bottom line. Under the Affordable Care Act, a wellness program is defined as one reasonably designed to promote health or prevent disease, and now final regulations have been issued with respect to the general requirements of wellness programs. These regulations set forth two main types of wellness programs: “participatory” and “health-contingent.” Participatory programs do not require employees to meet a certain health standard. They can, but are not required to, provide a reward to incentivize employees. Health-contingent wellness programs are of two types: “activity only” and “outcome-based.” Under an activity-only program, an individual is required to perform an activity related to a health factor in order to obtain a reward. In an outcome-based program, the individual must attain a specific health outcome in order to obtain a reward. In May of this year, the Equal Employment Opportunity Commission issued final rules for implementation of the ADA and the Genetic Information Nondiscrimination Act (GINA) in respect to employer wellness programs. Under the EEOC’s final rules for these laws, wellness programs are defined to include programs that are part of an employer-sponsored group health plan and those that are not tied to a group health plan. The authors provide an outline of expansion and clarifications under these rules for implementation of the ADA and the GINA.