Final Rules on Employer Wellness Programs

[1] The main issue at stake was whether such wellness programs, that require disability-related inquiries and/or genetic information as part of a wellness program, are still voluntary and not mandatory if they offer employees incentives for participating. (If the information is mandated, then it will be in violation of the ADA and GINA.)

Although the EEOC’s Final Rules are very similar to the proposed rules issued in 2015, the most notable changes are the following:

• All wellness programs must comply with GINA and the ADA whether part of a group health plan or not (addressing the interpretation that the Proposed Rules applied only to group health plans).
• The insurance safe harbor is not available to wellness programs. (The ADA contains a safe harbor provision for bonafide benefit plans based on underwriting, classifying or administering risks as long as the safe harbor provision is not used as a subterfuge to evade the purposes of the ADA. The purpose of the safe harbor provision is to permit development and administration of benefit plans using accepted principles of risk assessment.)
• Notice requirements apply to wellness programs separated from a group health care plan if the program solicits disability-related information or requires medical exams. The Notices must inform employees that the program is voluntary, and advise them what medical information will be obtained, how it will be used, who will receive it, and the restrictions on disclosure. (effective for plan years beginning on or after January 1, 2017). The EEOC published a sample Notice form – https://www.eeoc.gov/laws/regulations/ada-wellness-notice.cfm.

The EEOC specifically stated that the courts wrongfully applied the ADA’s safe harbor provision to two wellness programs in two cases, Seff v. Broward County[2] and EEOC v. Flambeau, Inc[3]., because neither employer used the wellness program data to determine insurability or calculate insurance rates, nor was there any evidence that the surcharge employed in both cases was based on actual risks that non-participating employees imposed. The Florida District Court in Seff held that the wellness program requiring completion of health risk assessments and biometric testing offered by the employer at issue did not violate the ADA and, in fact, fell under the ADA’s safe harbor provision. The Wisconsin District Court granted summary judgment against the EEOC in Flambeau, holding that the employers’ requirement that employees complete health risk assessments and biometric testing if they desired to participate in the group healthcare plan fell within the ADA’s safe harbor and did not violate the ADA.

The EEOC did not change its position that wellness programs requesting disability-related information or medical exams must be voluntary. Programs are voluntary if the employer does not require employees to participate; does not deny or limit coverage under any of its plans to non-participating employees; does not take adverse action, interfere with or retaliate against the non-participating employee; and provides notice to employees about what information is collected, how it will be used and with whom it will be shared, how it will be kept confidential, explains the restrictions on uses and disclosures, and explains the methods employed to prevent improper disclosure. A participant cannot be required to share medical information in order to participate in the wellness program.

The programs also must be reasonably designed to promote health and must not be a subterfuge for disability discrimination, meet certain notice requirements to employees, and limit the amount of incentives that may be offered for participation. In order to be reasonably designed, the collected information must address conditions identified through follow-ups with the participating employees, whether by providing information or advice, or creating programs to address the conditions identified and improve health.

Incentives up to 30% of the total cost of self-only coverage under the health care plan may be offered for participation in a wellness program. The Final Rules include guidance on how to calculate the cost of health care coverage for purposes of complying with the limitations on incentives effective for plan years beginning on or after January 1, 2017. If the employee does not participate in the group health plan, the employer may use the cost of single coverage if there is only one plan or the cost of the least expensive plan if there is more than one plan. If an employer has no health care plan, then the employer must calculate wellness program’s incentives to be 30% or less of the cost of self-only coverage for a 40 year old non-smoker under the second lowest cost Silver plan available through the Marketplace in the same location as the employer’s principal place of business.

GINA will be violated if an employer imposes a penalty on the participating employee or spouse for failing to achieve a certain health outcome. The maximum incentive for spousal participation is $1800, effective January 1, 2017.

Other useful information on these new rules can be found here:

Small Business Fact Sheets:
https://www.eeoc.gov/laws/regulations/facts-ada-wellness-final-rule.cfm
https://www.eeoc.gov/laws/regulations/facts-gina-wellness-final-rule.cfm

EEOC Q&A: https://www.eeoc.gov/laws/regulations/qanda-ada-wellness-final-rule.cfm

[1] Unless otherwise indicated, the rules apply effective immediately.

[2] Seff v. Broward County, 2011 U.S. Dist. LEXIS 44807 (S.D.Fla., April 11, 2011).

[3] E.E.O.C. v. Flambeau, Inc., 2015 WL 9593632, *1 (W.D. WI., December 31, 2015). See our blog titled “A Win For Wellness” posted on February 9, 2016.