Long before the Affordable Care Act (ACA) health care reform law, there was the Health Insurance Portability and Accountability Act—HIPAA. Among other provisions, HIPAA sets rules for wellness programs, limits pre-existing condition exclusion periods to no longer than 12 months and requires plans to provide employees with certificates of coverage.
The ACA and the law’s implementing regulations amend several HIPAA provisions.
Many wellness programs provide incentives for employees to quit smoking, lose weight and make other lifestyle changes to improve their health. Under HIPAA, incentives are limited to 20% of the total cost of employees’ coverage.
HIPAA divides wellness plans into two categories:
- Participation-only plans, where, for example, all employees need to do earn a reward is take blood pressure/cholesterol tests
- Health-contingent plans, where employees must meet a health-related standard before th...(register to read more)