At Last, Obamacare Benefits Incentives Rules Final and Clear

It’s been just over six years since the Affordable Care Act (ACA) became law and delivered a major shakeup to the American health care system. But since, parts of the healthcare industry haven’t changed: costs are still rising, and employers – who remain responsible for half of all Americans health care – are still paying too much it.

Fortunately, the ACA gave employers a valuable tool to both help improve employee health and keep costs in check. Jiff has long highlighted an oft-overlooked provision that expanded employers’ ability to offer incentives, like premium reductions, for employees (and spouses) engaging in healthy behaviors and wellbeing programs – like fitness tracking, smoking cessation, health assessments, and nutritional coaching.

This was great news for employers. They could take advantage of the ACA’s benefits incentives rules to lower healthcare costs, get the most out of their health programs, and develop a healthier workforce.

In many ways, the ACA was just a blueprint; the government had to write rules to accomplish the law’s goals.

However, while the ACA described some parameters for how employers could use incentives in employee health, the picture was far from clear. In many ways, the ACA was just a blueprint; the government had to write rules to accomplish the law’s goals. Questions remained about how employee health programs would fall under regulations prohibiting employment discrimination, health data security, and employee privacy.

The government had not clarified for employers exactly what health programs could incentivized, how to measure the incentives’ cost against the limit (30 percent of health plan’s cost), what employee health information they could or could not ask for, and how to accommodate certain groups of employees – like those with disabilities or employees’ dependents.

Jiff has closely tracked the federal government’s process in answering these questions, providing updates and explainers along the way. Now, finally, the process is complete and employers have a framework for their employee health benefits and programs.

Now, finally, employers have a framework for their employee health benefits and programs.

Late last month, the Equal Employment Opportunity Commission (EEOC) released its final rules governing employee wellness programs. These rules detail how and what employers can offer their employees wellness programs in compliance with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).

If you’ve read federal regulations before, you know they can be technical and hard to understand. That’s why Jiff hosted a webinar this month, Wellness Incentives: New Regulations and Best Practices, on the new rules and effective means of deploying incentives.

The EEOC’s new rules basically brought the ADA and GINA rules for employee health programs in line with the ACA’s. And, the rules explained that these regulations are to apply to all employee health programs, including those (1) offered only to employees enrolled in an employer-sponsored group health plan; (2) to all employees regardless of enrollment in the employer-sponsored group health plan; and (3) as a benefit of employment by employers that do not sponsor group health plans/insurance.

In brief, the rules also addressed:

ADA Rule:

The new rule allows employers to provide limited incentives as part of a wellness program that asks disability-related questions or requires medical exams. In order for the program to comply, those must be voluntary, reasonably designed to promote health or prevent disease, abide by the 30 percent incentive rule, and protect employee privacy.

GINA Rule:

The GINA rule implements the same requirements as the ADA rule and makes clear that an employer can offer a limited incentive to an employee whose spouse provides current or past health status information as part of a wellness program (children can be enrolled in a health program but not incentivized). However, it specifies that employers cannot deny health insurance or benefits access or retaliate against any employee whose spouse does not provide health information.

With the regulatory process to rest, employers can finally feel comfortable offering, and incentivizing, their employees health benefits programs that help improve health and save money. Jiff’s platform helps employers and employees make the most of these health benefits programs by bringing them together them in a data-driven hub that allows employers to manage all of them, to see what works, and to get employees to engage.