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Employment Wellness Programs Related Questions

Wellness programs are offered by companies ranging from Fortune 500 to mom and pop companies. As mandatory wellness programs are relatively new phenomena, there is no case law that covers all aspects of the program. However, employers have the right to introduce mandatory wellness programs as long as they are not in violation of the Health Insurance Portability and Accountability Act (HIPAA), the ADA, the Age Discrimination in Employment Act (ADEA), or the National Labor Relations Board (NLRB) rules.

Here, lawyers answer some of the top questions related to employee wellness programs.

Can an employee who has opted out of healthcare be forced to take a blood-test for health screening at a health & wellness program?

Unless there is a written contract to the contrary, an employer may require all his employees to participate in a health screening process, whether or not they are being insured. Additionally, the employer has the discretion to stop the money the employee may receive for opting out of the health insurance whenever the employer wishes. There is no legal obligation to pay an employee for opting out of insurance.

My company is implementing a wellness program, which gives us scores based on a health screening. These scores are followed by mandatory health goals, which decide our eligibility for the $500 health plan credit from the company. Is this an HIPAA violation?

If the plan gives you the option of refusing to participate in exchange for not being eligible for the $500 credit, it would not be considered a violation.

If the agency hired for screening health of the employees works directly for your employer, the results of the tests will not be considered confidential information that can be protected by HIPAA. Also, the employer is within legal rights to require you to sign an authorization to release your healthcare information to evaluate your eligibility in an insurance program.

My spouse’s employer is mandating participation in a wellness program with an organization that has a horrific history with me. I am concerned that my spouse may be terminated in the next round of layoffs because I'm too expensive to insure.

Any insurance company acts within its legal rights if it considers your medical history for insurance purposes. The insurance offered by your spouse’s company is not a legal obligation and therefore, they may place whatever conditions they wish. Further, the company has no obligation to offer a lower premium and is free to place any conditions on receipt of such premiums. While you may request them to use a second opinion from your doctor for their wellness program, you cannot legally force them to do so.

Can an employer make you pay the company up to $300 a year if you don't participate in the wellness program?

No, an employer may not. While an employer may provide an incentive to be in a wellness program by having employees who are members of the program pay less for their healthcare, they may not require an employee to pay for not participating in a wellness program. However, such employees may be required to pay a certain amount for the additional cost for healthcare. These are not direct payments to the employer.

Can I be forced to divulge my Protected Health Information (PHI) by my employer since it is the insurer that evaluates the insurance plans not the company? Isn’t this a violation of HIPPA?

While the employer does not have a right to your Protected Health Information (PHI), they may collect it from you to handover to the insurance company, which has a right to this information. While the doctor may not share your medical information with the employer, you are obliged as per the insurance agreement to share the information with your insurer, if you wish them to pay for your treatment.

The insurer can reduce your benefits if you do not release your health information as they have a legal right to your medical history as part of their risk assessment for the group plan in order to price the plans for the employers.

Typically, an employer may mandate a wellness program in an arrangement where the insurer agrees to provide less expensive premiums. It is the employer’s prerogative to choose not to provide or terminate health insurance for employees; or even require employees to pay for the increased insurance costs. Both employees and employers may benefit from speaking to a lawyer to understand their rights with regard to Employee Wellness Programs.
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