The Department of Labor's Employee Benefits Security Administration (EBSA), the Internal Revenue Service, and the Department of Health and Human Services have published final rules that provide guidance in complying with the nondiscrimination provisions of the Health Insurance Portability and Accountability Act (HIPAA).
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The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment, or other cost sharing requirements based on a health factor. However, there is an exception that allows plans to offer wellness programs.
The final regulations specify that wellness programs that condition a reward on an individual satisfying a standard related to a health factor must meet five additional requirements to comply with HIPAA's nondiscrimination rules.
Health factors include: health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), and disability.
Under the final regulations, examples of wellness programs that comply with HIPAA's nondiscrimination requirements without having to satisfy the additional standards (assuming participation in the program is made available to all similarly situated individuals) 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.
- A program that provides a reward to employees for attending a monthly health education seminar.
EBSA has issued updated frequently asked questions on HIPAA's nondiscrimination requirements to assist the employee benefit community in complying with the new rules.
The final rules are published in the Federal Register. The rules will be effective on the first day of the plan year beginning on or after July 1, 2007. For calendar year plans, the new rules generally apply beginning January 1, 2008.