Health reform beat goes on: New rules on wellness, ‘essential benefits”

The health reform wheels continue to grind: The feds have issued new guidance on wellness program incentives and the “essential health benefits rule.”

The guidance on wellness incentives does clear up some of the confusion about just what’s acceptable and what’s not. The info on the “essential health benefits”? Not so much.

Maximum incentive jumps by 10%

The Department of Health and Human Services (HHS), the DOL and Treasury Department recently released the new proposal for wellness incentives, which would apply to plan years beginning on or after Jan. 1, 2014.

The proposal’s just that — a proposal. But it does give employers a pretty good picture of what the final rules are likely to be.

Here are the highlights:

• The maximum incentive for “standards-based” wellness programs will jump to 30% of the cost of coverage (currently it’s 20%).
• The maximum incentive for programs designed to prevent or reduce tobacco usage can be up to 50% of the cost coverage.
• Reasonable alternatives must be provided to employees with medical conditions – or conditions where it’s medically inadvisable to comply the wellness program’s requirements.
• Employers can get physician verification from an employee to prove that a reason alternative to a wellness program is necessary – unless that employee’s medical condition is obvious or known to the plan or insurer already.

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