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Affordable Care Act – Wellness Programs

Learn about the Affordable Care Act's regulations on wellness programs for employers. Understand the different types of programs allowed and the rules for participation. Get insight into discrimination exceptions and alternative standards.

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Affordable Care Act – Wellness Programs

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  1. Affordable Care Act – Wellness Programs Cynthia Boyle Lande BrownWinick 666 Grand Avenue, Suite 2000 Des Moines, IA 50309-2510 Telephone: 515-242-2476 Facsimile: 515-323-8576 E-mail: lande@brownwinick.com

  2. Affordable Care Act Employers are prohibited from discriminating against health plan participants based on a health status factor when determining eligibility, benefits, or premiums. Exception: Wellness Programs

  3. Benign Discrimination Exception A health plan may discriminate in favor of an individual based on a health status factor

  4. Types of Wellness Programs • Participatory • Health-Contingent • Activity-Only • Outcome-Based

  5. Participatory Wellness Programs The employer must make the wellness program available to all similarly situated individuals, regardless of health status

  6. Health-Contingent Wellness Programs • Opportunity to Qualify Annually • Size of Reward • General Rule: 30% Cost of Coverage • Smoking Cessation Programs: 50% Cost of Coverage • Reasonable Design

  7. Health-Contingent Wellness Programs • Uniform Availability and Reasonable Alternative Standards • Additional requirements for Outcome-Based Wellness Programs • Notice of Availability of Reasonable Alternative Standards

  8. Website: www.brownwinick.com Toll Free Phone Number: 1-888-282-3515 OFFICE LOCATIONS: 666 Grand Avenue, Suite 2000 Des Moines, Iowa 50309-2510 Telephone: (515) 242-2400 Facsimile: (515) 283-0231 616 Franklin Place Pella, Iowa 50219 Telephone: (641) 628-4513 Facsimile: (641) 628-8494 DISCLAIMER: No oral or written statement made by BrownWinick attorneys should be interpreted by the recipient as suggesting a need to obtain legal counsel from BrownWinick or any other firm, nor as suggesting a need to take legal action. Do not attempt to solve individual problems upon the basis of general information provided by any BrownWinick attorney, as slight changes in fact situations may cause a material change in legal result.

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