How To Keep Your Wellness Program Compliant With GINA, ADA, And HIPAA - Webinar By TrainHR
Venue: Online Training
|Event Date/Time: Aug 22, 2012||End Date/Time: Aug 22, 2012|
HIPAA prohibits using health status to determine eligibility, contributions, or benefits. HIPAA does not prevent a plan from establishing discounts or rebates, or modifying copayments or deductibles, in return for adherence to bona fide wellness programs.
HIPAA nondiscrimination provisions generally prohibit plans from charging similarly situated individuals different premiums based on a health factor. The regulations also generally prohibit plans from requiring similarly situated individuals to satisfy different cost-sharing requirements. However, HIPAA does not prevent a plan from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles as a reward for members who adhere to health promotion and disease management programs.
A plan may not establish rules for eligibility that discriminate based on health-status-related factors. However, plans may implement wellness programs that provide incentives or rewards to employees who meet certain conditions and that do not provide the same rewards to employees who fail to meet those conditions. The Final Rules on Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, which were jointly issued by the IRS, the Department of Labor (DOL), and the Department of Health and Human Services (HHS) on December 13, 2006, promulgated regulations that permit such wellness programs only if they satisfy conditions falling under five headings. PPACA basically reaffirmed these regulations.
The webinar will describe the rules regarding these five areas, which are:
Maximum amount of a reward or penalty under a wellness plan
The scope of financial incentives
Qualification for the reward or avoiding the penalty
Alternative standards and
Documentation and disclosure.
The webinar will also discuss the GINA rules generally and specifically as they relate to health risk assessments (HRAs). HHS, the DOL, and IRS released an interim final rule prohibiting discrimination on the basis of an individual's genetic information under GINA. Under this rule, group health plans and health insurers may not request, require, or purchase genetic information to use in the underwriting process or in connection with enrollment in a plan, nor may plans or insurers ask or require individuals to submit to genetic testing. Prohibited uses of genetic information include collecting genetic information in the form of a family medical history prior to enrollment, as well as basing rewards for wellness programs on HRAs that request genetic information in the form of family medical history. Similar prohibitions apply to individual insurance. If an employer violates these rules, it will have to self-report the violation and pay an excise tax.
The ADA limits the circumstances under which an employer may require physical examinations or answers to medical inquiries. However, voluntary medical exams and inquiries are permitted as part of an employee health plan if certain criteria are met. The webinar will review these criteria and the one court case that addresses the impact of ADA on wellness plans. The webinar will also review other court cases related to wellness plans.
Why should you attend : High health care costs are driving more and more employers to implement wellness programs in an effort to avoid future large claims. A number of studies show good returns on investment for such programs. Some employers are providing financial incentives or penalties for success or failure related to the wellness programs. Before doing so, employers and other health plan sponsors need to be aware of the â€œrules of the roadâ€. Regulations issued under the Health Insurance Portability and Accountability Act (HIPAA) are quite specific as to the rules wellness plans must follow if they are to have any financial incentives. Running afoul of these rules could have very serious consequences for an employer or trust fund. Fortunately, the rules under the Patient Protection and Affordable Care Act (PPACA) are consistent with the HIPAA rules. The regulations under the Genetic Information Nondiscrimination Act (GINA) add another wrinkle. The Americans with Disabilities Act (ADA) may also affect wellness plans. To make matters worse, the Equal Employment Opportunity Commission (EEOC) has failed to take a position with regard to the ADA and wellness programs, which means that wellness programs designed to comply with the requirements under HIPAA and PPACA (health care reform) may violate the ADA. So far, only one court has ruled on the applicability of the ADA to wellness plans. Other lawsuits have been filed regarding wellness plans and more lawsuits are to be expected. In an area of uncertainty such as this, it is best for employers and other plan sponsors to be certain they do comply with the rules that exist.
Areas Covered in the Session
Who Will Benefit:
Vice Presidents of Human Resources
Human Resource Managers
Directors of Compensation and Benefits
Employee Benefits Consultants
Group Insurance Brokers
Employees of Wellness Programs
John Garner is the founding Principal of Garner Consulting, an employee benefit consulting firm in Pasadena. Under Garnerâ€™s leadership, this nationally recognized consultancy has built a broad base of services including benefits consulting, claim audits and compliance for insurance companies, employers, health care organizations and providers, and managed care companies. Garner Consulting recently merged its insurance brokerage division with two other brokerage firms to create Valence Benefits, where Garner also serves as a Principal.
Garner has expertise in the area of cost containment and is an acknowledged expert in the field of compliance-particularly the Health Insurance Portability and Accountability Act (HIPAA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Employee Retirement Income Security Act (ERISA).
Prior to founding Garner Consulting in 1987, he was a Principal in the Los Angeles office of Towers Perrin, where he worked for over 10 years. His professional experience also includes managing a group claim office for Lincoln National Life and supervising a claim office for Prudential, where he also served as an underwriter.
He has spoken to many industry organizations, including the International Society of Certified Employee Benefit Specialists, the International Foundation of Employee Benefit Plans and the Employers Health Care Coalition of Los Angeles. Garner is author of the Health Insurance Answer Book and co author of the three-volume Medical/Disability Claims Handbook, and has written numerous published articles. He is active in several professional organizations and has held many distinguished positions on their boards.
Garner earned his BA from Occidental College and holds several designations, including Chartered Life Underwriter, Certified Employee Benefits Specialist, and is a Certified Flexible Compensation Instructor.