Wellness Compliance Checker

Are employees requested or required to provide genetic information, or to complete a Health Risk Appraisal that includes family medical history questions?

Note: Genetic information does not include age, sex, or health screening data like body weight, cholesterol, or blood pressure.

Is the collection of genetic information or family medical history part of a research study?

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.

Is the collection of genetic information or family medical history used to determine eligibility or benefits in a group health plan?

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
• Disease management or prevention programs

It is best if these programs are all available to all employees.

Are participants in the wellness program required to meet any health standards in order to qualify for incentives or benefits?

Examples of health standards include completing a health risk assessment, participating in a health screening, or engaging in healthy behaviors.

Is the health standard that employees must meet based on health screening data (i.e. body weight, cholesterol, blood pressure), personal medical history, or addictive behaviors including tobacco use?

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.

Will the application of the standard based on health screening data, personal medical history, or addictive behaviors favor the employee by promoting better health?

Here are some examples where the application of a standard would promote better health:

• An employee with a chronic condition receives a premium discount for complying with a disease management program.
• An employee who smokes is offered a free smoking cessation program.
• An employee with elevated blood pressure is offered free health counseling.

Based on how you answered the previous question, you may not be compliant with federal nondiscrimination laws. Here are some things you could do to ensure that you are compliant:

• Make sure that your program promotes health improvement.
• Ensure that health standards are not used to penalize employees.
• Consider offering alternative standards or waivers for employees who cannot meet the health standard.

Congratulations! Based on your answers, your wellness program appears to be compliant with federal nondiscrimination laws.

Remember that this is a screening tool and should not be used as a substitute for qualified legal advice.

Congratulations! Your wellness program appears to be compliant with federal nondiscrimination laws regarding health-contingent wellness programs.

Remember that this is a screening tool and should not be used as a substitute for qualified legal advice.