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  • HHS Proposes Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

    A third proposed regulation issued today by the Department of Health and Human Services (HHS) offers amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage. Nondiscriminatory wellness programs generally allow premium discounts, rebates, or modification to otherwise applicable cost sharing (including copayments and deductibles) in return for adherence to certain programs of health promotion and disease prevention.

    Specifically, these proposed regulations would increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20% to 30% of the cost of coverage. In addition, the proposed regulations would further increase the maximum permissible reward to 50% for wellness programs designed to prevent or reduce tobacco use. These regulations also include other proposed clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.

    Comments on this proposed rule are due on or around January 26, 2013.   

    See related articles titled "HHS Releases Essential Health Benefits Proposed Rule" and "Proposed Rule Protects Patients From Discriminatory Policies."

    APTA's Regulatory Affairs department will provide full summaries of the 3 proposed rules shortly.

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