Can Health Plan Enrollment be Contingent on Completion of Health Risk Assessment (HRA)?

An Employer can require that its employees complete a HRA or participate in a qualified wellness program as a condition to enroll in the employer’s group health plan.  These employer requirements do not violate HIPAA nondiscrimination provision because enrollment is not conditioned on the employee’s health status or on attaining specific health outcomes.

 

Programs that comply with HIPAA, such programs are those under which none of the conditions for obtaining a reward is based on an individual satisfying a standard related to a health factor or under which no reward is offered.  These are       

·    A program that encourages preventive care through the wavier of the copayment or deductible requirement under a group health plan

·    A diagnostic testing program that provides a reward for participation and does not base any part of the reward on outcomes

·    A program that reimburses all or part of the costs for membership in a fitness center

·    A program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits

·    A program that provides a reward to employees for attending a monthly education seminar

·    a program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking; and

·    a program that provides a reward to employees for attending a monthly health education seminar.

 

IRS Reg. §54.9802-1(f)(1).

 

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