Implementing a workplace wellness program offers employers an excellent opportunity to improve the health, productivity and overall morale of employees and to reduce future health care costs. However, the question all employers must answer is “How does our organization ensure our wellness program is compliant with the Affordable Care Act (ACA)?” Learn more in this article.

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mplementing a workplace wellness program offers
employers an excellent opportunity to improve the
health, productivity and overall morale of employees
and to reduce future health care costs. The question all
employers must answer is “How does our organization
ensure our wellness program is compliant with the
Affordable Care Act (ACA)?”
In order to answer that question it is important to
know that the ACA divides wellness programs into two
types: Participatory and Health-Contingent. An employer’s
main focus when introducing either type of program must
be avoiding discrimination and providing goals that are
obtainable for all employees.
Participatory Wellness Program
The participatory program is pretty straightforward
and centered solely on employee participation, not a
specific outcome. An example is offering reimbursement
for the employee’s cost of a monthly gym membership. If
introducing a participatory program, there should never be
a reward or incentive for something outcome based. Also,
be sure the health incentives set forth are possible for
any employee to complete regardless of health status; for
example, completing a health risk assessment or going
to one’s annual preventive care appointment. Regardless
of the results from the assessment or the biometric
numbers obtained at a preventive care appointment, the
employee would be rewarded simply because he or she
completed the task.
Health-Contingent Wellness Program
Health-contingent programs can be a bit tricky when
looked at from a discrimination viewpoint as they require
the employee to meet a specific goal (e.g., stopping
tobacco use) in order to obtain a reward. These programs
can be broken out further into “Activity Only” or “Outcome
Based”.
“Activity Only” rewards the employee for accomplishing
a certain activity (e.g., walking 30 minutes a day, three
days a week), but does not depend on numerical goals
like weight loss, BMI or blood pressure. Conversely,
“Outcome Based” does not reward an employee for simply
participating in an activity but rather requires achieving
or maintaining a specific health goal, such as obtaining
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Is Your Wellness Program ACA Compliant?
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a BMI of 28 or less. Thus, the model of reward based
on outcomes can lend itself to discrimination issues,
especially if an employee cannot reasonably accomplish
a goal due to conditions such as health status or safety
issues. Therefore, it is always necessary to offer alternative
means of accomplishing a specific goal or task and make
sure the reward is the same as that being offered to other
employees.
Lastly, the ACA specifies the 2014 maximum
permissible reward for health-contingent wellness programs
to be 30% of the cost of the employee-only health
coverage. This means annual rewards, whether health care
premium subsidies or tangible items, cannot exceed this
amount.
In summary, wellness programs are an effective way
for an organization to improve many facets of employee
health and wellbeing, as well as to exert some control
over future health care costs. Just be cognizant to design
a program that is compliant with ACA requirements.