The Wellness Compliance Checker was designed to help workplace wellness programs stay compliant with ERISA, HIPAA and GINA.
This is a compliance screening tool and should not be used as a substitute for qualified legal advice.
Please answer "Yes" or "No" as prompted.
You can collect genetic or family medical history information for research purposes if you meet these requirements:
- The party sponsoring or conducting the research obtains approval from an Institutional Review Board.
- Participants provide written permission for you to gather genetic or family medical history information.
- Participants understand that their participation is voluntary, secure, and confidential.
- Participants are informed that their data will not be used to determine eligibility or benefits in a group health plan.
- You complete and submit a Federal form that documents a research exception to GINA.
Based on your answers, your wellness program may not be compliant with federal nondiscrimination laws. Here are things you can do to bring your program into compliance:
- Make sure that group health plan enrollment, continued eligibility, and benefits (deductibles, premium or co-pays) are not based on the provision of genetic or family medical history information.
- Make sure that wellness rewards or incentives are not based on the provision of genetic or family medical history information.
Things to Remember About GINA
1) If you request employees to complete a Health Risk Appraisal (HRA), you can be GINA compliant by using an HRA with no family medical history questions.
2) A health insurance company can require a genetic test to determine medical necessity for payment of a claim.
3) Group health plans can still reward participation in:
- An annual physical,
- Preventive services, or
- Disease management or prevention programs
It is best if these programs are all available to all employees.
Based on how you answered previous questions, you may not be compliant with some federal nondiscrimination laws. Here are some things you could do to ensure that you are compliant:
- Base rewards on participation in your wellness program and not on health screening data, personal medical history, or addictive behaviors. For example, you can base a reward on participation in a blood pressure screening rather than on blood pressure values.
- Make sure that wellness rewards or incentives are not tied to either health plan eligibility (e.g. enrollment, effective date, or waiting period), or benefits (e.g. premiums, deductibles, co-pays, co-insurance or surcharges). Rewards such as gift cards or paid days off are good examples of rewards that are NOT tied to the health plan.
NOTE: More advanced wellness programs may base rewards on health screening data or may tie these data to health plan benefits. These are called "outcomes-based" or "health-contingent" wellness programs and are legal if you follow the rules. We will help you understand these rules in a few steps.
Based on how you answered the previous question, you may not be compliant with federal nondiscrimination law. Here are a few things you could do to ensure compliance:
- Make sure that your wellness incentives make it easier for those with adverse health factors to manage and improve their health.
- Make sure that employees can participate in disease prevention programs without having to meet any other standards. For example, an employee who smokes should be eligible to enroll in a smoking cessation program regardless of their body weight, medical history or other unrelated factors.
Your wellness program is compliant with federal nondiscrimination provisions.
To further help you in your efforts, here is some specific language recommended to explain alternative programming options for those who are unable to participate for whatever reason.
"Rewards for participating in the wellness program are available to all employees. If you feel that you cannot meet a standard for a reward under the wellness program, you may still be able to earn the same reward. Contact us at [insert contact information] and we will work with you to modify the wellness program.
If it is unreasonably difficult due to a medical condition for you to achieve the standards for the reward under this program, call us at [insert contact information] and we will work with you to develop another way to qualify for the reward."
You are not in compliance with the federal nondiscrimination provisions. You can bring your program into compliance by making the changes necessary to enable you to answer, "Yes" to the following questions:
Contact us to learn how WellSteps wellness solutions can help you improve employee health.
You’re done and it appears your program is in compliance with federal nondiscrimination laws.
You’re done and it appears you’re in compliance with federal nondiscrimination laws.