Posts Categorized: Wellness Programs

11th Circuit Upholds Broward County

in Health Benefits, Wellness Programs

Yesterday, the US Court of Appeals for the 11th Circuit upheld summary judgment in favor of the employer in Seff v. Broward County. This was a case that has been intensely watched due to the implications for wellness plans. In the Broward County case, Broward offered a wellness program sponsored by Broward’s group health insurer. The employee wellness program consisted of two components: a biometric screening, and an “online Health Risk Assessment questionnaire.” The insurer used information gathered from the screening and questionnaire to identify Broward employees who had one of five disease states: asthma, hypertension, diabetes, congestive heart failure,… Continue Reading

Voluntary Wellness Programs

in Wellness Programs

An exemption exists from the Americans with Disabilities Act (ADA) for wellness programs, if the wellness program is “voluntary.”  The EEOC has yet to rule on what amount of financial or other inducements will make a wellness program “involuntary,” thereby violating the ADA rules.  For the most part, plan sponsors have continued offering minor inducements, such as gift cards, deductible waivers, and copay waivers, for those individuals who participate in a wellness program.  For the latest iteration of this long-running issue, the ABA Joint Committee on Employee Benefits asked the EEOC various voluntariness questions.  As the EEOC has done for the past… Continue Reading

Participants Sue Wellness Program

in Court Cases, Welfare Benefits, Wellness Programs

Last week a federal district court in Florida certified a class action against Broward County Florida’s health plan.  The class action alleges that the plan’s wellness program violates the Americans with Disabilities Act (ADA) by charging employees a $20 bi-weekly surcharge for not participating in a wellness program.  The wellness program required biometric testing (glucose and cholesterol) and completion of an online health risk assessment.  If participants did not complete the testing and health risk assessment, participants were charged a $20 bi-weekly surcharge.  While these kinds of programs are allowed under HIPAA and ERISA (subject to certain requirements), the EEOC has been mostly… Continue Reading

Wellness Surcharges

in Affordable Care Act, Wellness Programs

The month of January has been slow with respect to any new guidance coming out of the Agencies.  The Agencies appear to be taking a rest from the work in 2010.  However, one item that I have recently worked on is how to calculate the 5% reduction in the cost of coverage for grandfathered plans, when a new wellness program commences.  Employers who did not have a wellness program in 2010, but who have started a wellness program in 2011 are somewhat disadvantaged when it comes to retaining grandfathered status.  This is because the 2010 employee premiums did not include… Continue Reading

DOL RFI for Preventive Care

in Affordable Care Act, Wellness Programs

As noted last week, the DOL announced on its webpage that it would publish an RFI regarding possible value-based plan designs in light of the preventive care requirements.  (A nongrandfathered plan is required to provide preventive care, as defined by the Agencies, at 100% with no deductible and no coinsurance for in-network claims.)  Based on the preventive care requirements, it is hard to see how plans could offer incentives in the context of preventive care (unless the existing regulations are revised).  However, the Agencies remain interested in ideas on how this could be accomplished.  Specifically, the RFI solicits information on specific examples… Continue Reading