The last discussion laid out the nuts and bolts of the final government regulations on corporate wellness programs. They go into effect on the first of the new year, and finalized most of the regulations that were proposed late last year.
Here's a quick review:
- Wellness programs are split between participatory wellness programs (PWPs) and health-contingent wellness programs (HWPs).
- There are two types of health-contingent programs: activity-only (AWPs) and outcome-based (OWPs).
- Participatory programs are largely unchanged from the 2006 regulations.
- Health-contingent programs have five criteria they must meet in order to fulfill the nondiscrimination rules of HIPAA.
- The most important criterion for HWPs is likely to be structuring their programs to provide reasonable alternative standards (RAS's) that satisfy the regulatory language and aren't smokescreens for health factor-based discrimination.
The third section of the OFR document speculates on economic, paperwork, and federalism impacts of these regulations. Let's get the easiest part out of the way first.
The final regulations require group health plans and group health insurance issuers to disclose the availability of reasonable alternative standards and waivers in all plan materials that describe the terms of a health-contingent wellness program. (See the overview's section on disclosure for full details.)
If your company already has a wellness program in place, and doesn't plan on making any drastic changes, your paperwork shouldn't change much. Most of the information required at the federal level is already mandated either by typical business practices of health plans and health insurance issuers, or by state or local regulations.
On the flip side, let's say your company doesn't currently have a wellness program in place. Senior management decides to begin a program at the start of 2014. Well, now you'll have some work to do.
Once the nuts and bolts of the proposed wellness program are confirmed, management will have to work with its group health plan / health insurance issuer to change the health plan's summary plan description (SPD) and issue a summary of the material modifications (SMM). Right now, when the materials of a health plan are changed, SPDs must be provided every five years. SMMs, on the other hand, have to be issued within 210 days after the end of the plan year in which the change was adopted. They must also be given to plan participants and beneficiaries by the plan administrator.
This has been the standard process since at least 2000, when the last substantive change to OMB #1210-0039 was made. The new wellness program regulations should not change this process much, if at all.