Affordable Care Act – Wellness Programs Cynthia Boyle Lande BrownWinick 666 Grand Avenue, Suite 2000 Des Moines, IA Telephone: Facsimile:
Affordable Care Act Employers are prohibited from discriminating against health plan participants based on a health status factor when determining eligibility, benefits, or premiums. Exception: Wellness Programs
Benign Discrimination Exception A health plan may discriminate in favor of an individual based on a health status factor
Types of Wellness Programs Participatory Health-Contingent Activity-Only Outcome-Based
Participatory Wellness Programs The employer must make the wellness program available to all similarly situated individuals, regardless of health status
Health-Contingent Wellness Programs Opportunity to Qualify Annually Size of Reward General Rule: 30% Cost of Coverage Smoking Cessation Programs: 50% Cost of Coverage Reasonable Design
Health-Contingent Wellness Programs Uniform Availability and Reasonable Alternative Standards Additional requirements for Outcome-Based Wellness Programs Notice of Availability of Reasonable Alternative Standards
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