Wellness Compliance Checklist : OneDigital Benefits Compliance Consulting

TABLE OF CONTENTS

Examples of Wellness Programs
Voluntariness
Limit on Employee Reward/Penalty
Limit on Dependent Reward/Penalty
Alternative Rewards to Include
Must Offer Opportunity to Earn Reward
Reasonable Alternative Standard Required
Physician Involvement
RAS Notice Requirement
EEOC Wellness Notice

Types of Wellness Programs:	Participation	Participation: Disability-Related	Activity	Outcome
Do you offer any of the following types of wellness programs? Check All that Apply
Examples of Wellness Programs	Lunch and Learn Health or Stress Coaching Education Disease Management Education On-Site Fitness Center Healthy Meal Options	Health Risk Assessment Biometric Screening Annual Physical/Exam Health Screenings (Health Fair; Cancer; Mammogram) Tobacco Cessation Program	Physical Activity Program (Walk/Run) Fitness Program Weight Management Program	Result-Driven Health Risk Assessment Result-Driven Biometric Screening Surcharge: Non-Tobacco User Status Weight Loss Competition Result-Driven Physical Activity
*Are employees, spouses, or dependent children required* to participate in the wellness program? YES ___ NO ___**
Voluntariness	Program Must Be Voluntary Does not require participation Does not deny access to health plan(s) for non-participating employee Does not take adverse action against non-participating employee: retaliate, interfere, coerce, intimidate, threaten	Program Must Be Voluntary Does not require participation Does not deny access to health plan(s) for non-participating employee Does not take adverse action against non-participating employee: retaliate, interfere, coerce, intimidate, threaten	Program Must Be Voluntary Does not require participation Does not deny access to health plan(s) for non-participating employee Does not take adverse action against non-participating employee: retaliate, interfere, coerce, intimidate, threaten	Program Must Be Voluntary Does not require participation Does not deny access to health plan(s) for non-participating employee Does not take adverse action against non-participating employee: retaliate, interfere, coerce, intimidate, threaten
Does your wellness program comply with the employee incentive/penalty limits under HIPAA, the ACA, the ADA, and GINA? YES ___ NO ___
Limit on Employee Reward/Penalty To ensure compliance with HIPAA, ACA, ADA, and GINA, apply lowest incentive limit. Note: The proposed ADA & GINA rules were withdrawn 1/21/21 and are not effective yet. *50% for tobacco-related outcome-based program.	General (HIPAA/ACA): Unlimited Reward/Penalty	General (HIPAA/ACA): Unlimited Reward/Penalty Disability-Related (ADA): 30% of TOTAL Cost of Coverage (if tied to the health plan) De minimis (if not tied to the health plan) EE & ER Cost x 0.30 = Max. Incentive $_________ x 0.30 = ____________	General (HIPAA/ACA): 30% of TOTAL Cost of Coverage Disability-Related (ADA): 30% of TOTAL Cost of Coverage (if tied to the health plan) De minimis (if not tied to the health plan) EE & ER Cost x 0.30 = Max. Incentive $_________ x 0.30 = ____________	General (HIPAA/ACA): 30%* of TOTAL Cost of Coverage Disability-Related (ADA): 30% of TOTAL Cost of Coverage (if tied to the health plan) De minimis (if not tied to the health plan) EE & ER Cost x 0.30 = Max. Incentive $_________ x 0.30 = ____________
Are spouses or dependent children allowed to participate in the wellness program to receive incentives? YES ___ NO ___
Limit on Dependent Reward/Penalty	General (HIPAA/ACA): Unlimited Reward/Penalty	Spouse/Dependent (GINA): De minimis	Spouse/Dependent (GINA): De minimis	Spouse/Dependent (GINA): De minimis
Did you take account for rewards other than premium differentials in calculating your incentive limit? YES ___ NO ___
Alternative Rewards to Include Excludes de minimis items: “trinkets” such as t-shits, cups/bottles, stress balls, pens etc.	General (HIPAA/ACA): Unlimited Reward/Penalty	HSA/HRA/FSA Contribution Cash (never de minimis) Gift Cards (never de minimis) Wearables/Fitness Trackers Vacation/Trips Non-De Minimis Raffles	HSA/HRA/FSA Contribution Cash (never de minimis) Gift Cards (never de minimis) Wearables/Fitness Trackers Vacation/Trips Non-De Minimis Raffles	HSA/HRA/FSA Contribution Cash (never de minimis) Gift Cards (never de minimis) Wearables/Fitness Trackers Vacation/Trips Non-De Minimis Raffles
How often do you offer participants an opportunity to earn the reward? Every ________________
Must Offer Opportunity to Earn Reward	No Restrictions	At Least Once Per Year – if tied to the health plan) No Restrictions – if not tied to the health plan)	At Least Once Per Year	At Least Once Per Year
Do you offer a reasonable alternative standard (RAS) to participants that are unable to satisfy the original requirements of the wellness program? YES ___ NO ___
Reasonable Alternative Standard Required	No	Yes Participant must earn reward for same plan year RAS satisfied If participant satisfies RAS mid-year, credit reward/penalty back to beginning of plan year for ongoing employees or date of eligibility for new hires	Yes Participant must earn reward for same plan year RAS satisfied If participant satisfies RAS mid-year, credit reward/penalty back to beginning of plan year for ongoing employees or date of eligibility for new hires	Yes Participant must earn reward for same plan year RAS satisfied If participant satisfies RAS mid-year, credit reward/penalty back to beginning of plan year for ongoing employees or date of eligibility for new hires
Do you require verification from the participant’s physician that he or she needs a reasonable alternative standard? YES ___ NO ___
Physician Involvement	Can Require Verification: Not Applicable Must Accommodate: Not Applicable	If tied to the health plan - Can Require Verification: Yes Must Accommodate: Yes	Can Require Verification: Yes Must Accommodate Recommendation: Yes	Can Require Verification: No Must Accommodate Recommendation: Yes
Do you provide participants with a Notice of Availability of Reasonable Alternative Standard? YES ___ NO ___
RAS Notice Requirement	Notice Required: No	Notice Required: Yes; provided in all plan materials describing wellness program – if tied to the health plan	Notice Required: Yes; provided in all plan materials describing wellness program	Notice Required: Yes; provided in all plan materials describing wellness program
Do you provide participants with the required notice for wellness programs? YES ___ NO ___
EEOC Wellness Notice	General (HIPAA/ACA): No Disability-Related (ADA): No Child/Spouse (GINA): Yes	General (HIPAA/ACA): No Disability-Related (ADA): No Child/Spouse (GINA): Yes	General (HIPAA/ACA): RAS Disability-Related (ADA): No Child/Spouse (GINA): Yes	General (HIPAA/ACA): RAS Disability-Related (ADA): No Child/Spouse (GINA): Yes