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Flow Chart of Key Wellness Program Regulations

A wellness program is any formal or informal program that educates employees about health-related issues, promotes following healthy lifestyles, or encourages employees to make healthier choices. Wellness programs vary greatly and are not always called wellness programs. Some are purely educational and have no financial incentives. Others have financial incentives that may take the form of reductions in the employee’s contribution for medical coverage, reduced deductibles or copays, gift cards, cash or prizes (such as T-shirts, mugs, tickets, etc.).
Increased Regulatory Requirements
Wellness programs are regulated by more federal agencies and regulations than can be practically listed. However, in recent years, the Health Insurance Portability and Accountability Act (HIPAA), the Patient Protection and Affordable Care Act (ACA), the Genetic Information Nondiscrimination Act (GINA), and the Americans with Disabilities Act (ADA) have become the frontrunners in wellness program regulation. As a result, it can often be very difficult for an employer with an existing wellness program, or one considering a wellness program, to understand which regulations apply to them. The answer is typically based on a wellness program’s plan design.
Flow Chart of Wellness Regulations
UBA has created a flow chart with decision trees to help employers ascertain which rules apply to their wellness program as a result of its design. The flow chart is not intended to be all-encompassing, and due to their highly regulated nature, employers should have their attorneys review and approve any wellness program.
The flow chart is not intended to explain the definitions behind commonly used terms in wellness programs, but instead to pinpoint a program’s applicable regulatory rules.
Employers should work numerically from question one to question five. For each question, there is a decision tree to work through. At the end of the flow chart, an employer should have a basic understanding of which regulations apply to their wellness program design.
Conflicting Rules
If a wellness program is governed by multiple regulations (such as HIPAA, the ADA, and GINA), the employer should always follow the more stringent set of rules whenever the regulations conflict in their guidance. Where they do not conflict, the employer should meet the requirements of both.
Content provided by our partner, United Benefit Advisors.