QUESTION

I had to complete a health risk assessment and now my employer is offering me a discount on my health insurance premiums if I will lose weight, stop smoking, and lower my blood pressure. What are my rights?

Post enrollment issues | Employer-Sponsored Coverage
ANSWER

Your employer can offer rewards or penalties to encourage employees to take a health risk assessment, and there are no limits on employers that do just that. If, however, you must also meet a health standard, like losing weight or lowering your blood pressure, your employer must meet additional requirements. Those requirements are:

  • Every individual must be given an opportunity to qualify for the reward (or avoid the penalty) once a year;
  • The rewards or penalties can total no more than 30 percent of the cost of coverage (including both your share and your employer’s share of the premium) or 50 percent of your premiums for programs to reduce tobacco use; this can be in the form of lower (or higher) premiums, deductibles or co-pays (but the limit applies to the total value of all penalties/rewards);
  • The workplace wellness program must have a reasonable chance of improving health or preventing disease and not just be a way to discriminate against workers based on their health; and
  • Those individuals who can’t meet the health standard must be given a reasonable alternative standard to meet. Where the program focuses on activities related to a health condition – such as weight loss programs for people with high body mass indices (BMIs) – an individual may be required to show proof that their doctor has advised against the program. But programs that require individuals to meet the standard (for example, a BMI of 29) or pay more must make a reasonable alternative standard available to anyone who can’t meet the health target. Any plan materials that describe the program must also give you information on how to request an alternative standard.

If you have concerns about the program your employer is offering, you can contact the Department of Labor via the information here or call 1-866-444-3272. (45 C.F.R. § 146.121).

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