Content area
Abstract
Employers interested in adopting wellness programs should analyze the proposed design to determine HIPAA nondiscrimination compliance. Employers with insured plans must consider some state insurance laws that may limit their ability to implement a HIPAA-compliant wellness program. In particular, although most states permit contribution and co-payment incentives for participation in a wellness program, a few states do not. They impose a strict limit on using health status to determine not just eligibility but also other terms of a health plan or policy, and these state laws do not permit any exception. Although a wellness program may be HIPAA-compliant, it may still need to comply with the ADA. Thus, designing wellness programs also requires a basic understanding of the ADA. Employers need to remember that ADA'S protections are independent of HIPAA's. Following are two obvious examples. First, the ADA will apply to a wellness program, regardless of whether its incentives involve a group health plan. Second, unless a program qualifies for the voluntary wellness program exemption, the ADA generally will prohibit the employer from conducting medical exams or disability inquiries that are not job-related or justified by business necessity. This is true, even when undergoing the exam or responding to the inquiry is the only condition for earning the program's incentives. Besides these examples, the two laws have other differences, and employers should seek legal advice in navigating these requirements.