Making sense of the ACA wellness provisions


While the ACA published and put into effect new wellness provisions in early 2014, we’re just now seeing the first few court cases, resulting in a flurry of articles this week.

The ACA was a dense legislation, leaving a lot of question marks in the eyes of experts, let alone the employers looking to incorporate wellness into their culture. And Vitality offered education and guidance to ensure clients were in compliance.

In the past 30 days, the EEOC has seen two similar cases of wellness programs gone astray. In both cases, the company implementing the wellness program has put such heavy incentives on participation in the program, they have been deemed “involuntary.” The requirement, in both cases, determined whether the employee would bare the entire cost of the health care premiums, a huge expense to any employee. The EEOC found such a high incentive made the requirements just that, requirements, not voluntary decisions with an incentive to boost personal wellness. These recent court cases, while shedding light on aspects of the legislation, even more so shed light on the need for guidance and consultation when making wellness decisions.

Since the ACA laws were published, many in the wellness arena are concerned that it created an “easy button,” rather than a motivational tool to improve health and wellness. However, as these court cases show, it’s not the regulations that are the problem. It’s the need to choose and implement a program that is reasonably designed to improve wellness, and not to discriminate or punish those who choose not to participate. The recourse of choosing a program off the shelf without looking into its design can lead not only to heavy litigation as two companies have already seen, but also to discouraging employees from participating, rather than encouraging.

This legislation and the regulations surrounding wellness are dense and complicated, and these first cases show the importance of working with experts to find and choose a program that is well designed and legal. Such programs will not only keep you and your company compliant, but will also promote and encourage employees to see health improvements.

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