WORKPLACE WELLNESS & THE LAW

YOUR ACA , H IPAA AND ER ISA COMPL IANCE CHECK-UP

• A culture of wellness is an environment that encourages people to address their own health issues and overall well-being within the workforce environment.

• In the workplace, a culture of wellness encourages employees to participate and actively engage themselves in self-care and self-management of health conditions.

• The main focus in a culture of wellness is the prevention of diseases and chronic disease management.

• A culture of wellness creates a productive, low-stress, reduced absenteeism, healthy environment that supports employees in their journey to better health while reducing the company’s costs in healthcare claims.

W H AT I S A C U LT U R E O F W E L L N E S S ?

Top 5 cost driving factors.• Orthopedic• Cardiac disease• Diabetes• Respiratory illness• Behavioral health

These are the areas that are the most manageable and have the most potential for positive impact in a wellness program.

C R E AT I N G A W E L L N E S S C U LT U R E

Top 5 health-risk behaviors.• Lack of physical activity• Ineffective stress management• Poor eating habits• Unsuccessful weight management• Tobacco use

C R E AT I N G A W E L L N E S S C U LT U R E

The final rules continue to support participatory wellness programs, which are generally available without regard to an individual’s health status. These include programs that reimburse for the

cost of membership in a fitness center, that provide a reward to employees for

attending a monthly, no-cost health education seminar, or that reward employees who complete a health risk assessment, without requiring them to take further action.

PA RT I C I PAT O RY W E L L N E S S

• Participatory wellness programs comply with the nondiscrimination requirements without having to satisfy any additional standards, as long as participation in the program is made available to all similarly situated individuals, regardless of health status.

PA RT I C I PAT O RY ( C O N T. )

• Eligible employees must have the opportunity to qualify for the reward yearly.

• The reward can't exceed 30% of the cost of employee-only medical plan coverage (including the employee and employer portion of coverage cost).

• If an employee's dependents can participate, the reward can be based on 30% of the cost of coverage for the employee and her dependents. If the program is designed for tobacco cessation, the top reward can be 50% of the total coverage cost. The reward limit is cumulative for all health-contingent wellness programs.

H E A LT H - C O N T I N G E N T W E L L N E S S

• The program must be designed to improve health or prevent disease.

• In an activity-based wellness program, the full reward must be available to similar individuals by offering an alternative standard for earning the award if achieving the original standard goes against a doctor's advice. A doctor's verification may be needed to set an alternative standard. Activity-based programs require an individual to perform or complete an activity related to a health factor in order to obtain a reward (for example, walking, diet or exercise programs).

H E A LT H - C O N T I N G E N T W E L L N E S S ( C O N T. )

• The program must be designed to improve health or prevent In an outcome-based wellness program, the full reward must be available to employees who failed to meet the standard based on an initial screening.

• If the employee needs an alternative standard, the final rules say that employees must be given additional time to reach a different level of the same standard. The employee's doctor can be involved in setting the alternative standard.

• Outcomes-based programs require an individual to attain or maintain a certain health outcome in order to obtain a reward (for example, not smoking, attaining certain results on biometric screenings or meeting exercise targets).disease.

H E A LT H - C O N T I N G E N T W E L L N E S S ( C O N T. )

• Wellness program materials must disclose the availability of a reasonable alternative standard that can be met for the full reward. Outcome-based wellness programs must include a similar statement when notifying employees that they did not meet the original standard.

• To summarize: Participatory programs get you thinking about health (but do not impact health status); activity-only programs get you acting on health (and may impact health status); and outcome-based programs measure healthiness.

H E A LT H - C O N T I N G E N T W E L L N E S S ( C O N T. )

• The Department of Labor (DOL) has released a new final summary of benefits and coverage (SBC) form and related materials. You can find the new form on the Summary of Benefits and Coverage and Uniform Glossary page of the DOL website.

• The new SBC must be used for open enrollment periods that begin on or after April 1, 2017, for coverage in plan years that begin on or after April 1, 2017. 

• The current SBC template for use through March 31, 2017 also remains available on the DOL website.

• The SBC is intended to help people better understand their health plan coverage

A C A U P D AT E S - S B C

• What is it? Permanent, annual tax beginning in 2020 on high-cost employer-sponsored health coverage.

• The tax is 40% of the cost of health coverage that exceeds predetermined threshold amounts.

• Cost of coverage includes the total contributions paid by both the employer and employees, but not cost-sharing amounts such as deductibles, coinsurance and copays when care is received.

A C A U P D AT E S – T H E E XC I S E ( C A D I L L A C ) TA X

• For planning purposes, the thresholds for high-cost plans are currently $10,200 for individual coverage, and $27,500 for family coverage.

• These thresholds will be updated before the tax takes effect in 2020 and indexed for inflation in future years.

• Congress has passed a two-year "Cadillac Tax" delay, postponing the effective date to 2020.

• It has NOT gone away, be prepared

A C A U P D AT E S – T H E E XC I S E ( C A D I L L A C ) TA X

• The pay-or-play provision imposes a penalty on large and midsize employers that don’t offer “minimum essential” health care coverage.

• The employer’s insurance coverage will fail this test if it is deemed “unaffordable” or doesn’t provide at least “minimum value” to full-time employees (and their dependents).

• The penalties become effective if one or more full-time employee enrolls in a qualified health plan through a government-run health insurance exchange and receives a premium tax credit.

A C A U P D AT E S – PAY O R P L AY

• A large employer is one that has 50 full-time employees or a combination of full-time and part-time employees that are equivalent to at least 50 FTEs.

• Large employers must offer at least 95% of their full-time employee’s minimum essential health coverage to avoid the annual penalty of $2,000 per full-time employee in excess of 30 full time employees.

A C A U P D AT E S – PAY O R P L AY

• The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued two reports recently calling for the HHS Office of Civil Rights (OCR) to strengthen its Health Insurance Portability and Accountability Act (HIPAA) enforcement efforts.

• In response to these reports, HHS announced that it will launch HIPAA audits early 2016 in order to be more proactive in HIPAA enforcement.

2 0 1 6 – T H E Y E A R O F T H E H I PA A A U D I T

• ERISA wrap requirements for benefit plan docs

• Enforcement of FORM 5500 Wrap Docs

• Retirement Plans Deductibility of IRA contributions – spouses, Roth Changes to AGI for Retirement savings

contribution tax credit for low & moderate income workers

E R I S A U P D AT E S

• On June 30, 2015, the United States Department of Labor (DOL) released proposed regulations that would modify certain provisions of the Fair Labor Standards Act (FLSA). Specifically, the proposed regulations increase the minimum salary required to be earned by an employee in order for that employee to be exempt from the FLSA overtime requirements.

• Are you planning for this impact?

A N D T H E N T H E R E I S F L S A !

Q U E S T I O N S ?

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