Health plan enrollment can be contingent on completion of health risk assessment


Issue:

As benefits manager, you are thinking about requiring employees to complete a health risk assessment questionnaire in order to be eligible for employer-provided health insurance. May an employer do this? What about requiring employees to participate in a wellness program?

Answer:    

Yes, an employer can require that its employees complete a health risk assessment or participate in a qualified wellness program as a condition to enroll in the employer’s group health plan. These requirements do not violate HIPAA nondiscrimination provisions because enrollment is not conditioned on the employee's health status or on attaining specified health outcomes (such as lowering cholesterol to a certain level or reducing weight to a certain target).

Programs that comply with HIPAA. Final regulations contain a list of programs that comply with HIPAA’s nondiscrimination requirements without having to satisfy any additional requirements (assuming participation in the program is made available to all similarly situated individuals). Such programs are those under which none of the conditions for obtaining a reward is based on an individual satisfying a standard related to a health factor or under which no reward is offered. These include:

  • a program that reimburses all or part of the cost for memberships in a fitness center;
  • a diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes;
  • a program that encourages preventive care through the waiver of the copayment or deductible requirement under a group health plan for the costs of, for example, prenatal care or well-baby visits;
  • a program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking; and
  • a program that provides a reward to employees for attending a monthly health education seminar.

Source: IRS Reg. §54.9802-1(f)(1).

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