DOL Clarifies When HIPAA Applies to Wellness

March 11, 2008

The Final HIPAA Nondiscrimination Regulations were issued in late 2006 and went into effect last summer, but the DOL has received a surprising number of questions as to when and how these rules apply to wellness programs. Last month, the DOL provided additional guidance in Field Assistance Bulletin 2008-02.

As a review, the regulations prohibit group health plans from basing eligibility, premiums or benefits on an individual's health factor. An exception to the rule exists for wellness programs that have certain mandated features. The DOL defined what a wellness program is. They "can be called many things. Other common names include: disease management programs, smoking cessation programs and case management programs."

The wellness regulations apply only to wellness programs offered through group health plans. "If the employer operates the wellness program as an employment policy separate from the group health plan, the program may be covered by other laws, but it is not subject to the group health plan rules discussed here."

The Field Assistance Bulletin provides an easy-to-follow checklist for determining how a wellness program can comply with HIPAA. The checklist contains straightforward yes/no questions, and depending on how you answer the questions, you can know whether you have a compliance issue.

A copy of the Field Assistance Bulletin is available at www.dol.gov/ebsa/pdf/fab2008-2.pdf.

As a reminder, Infinisource has partnered with Elite Wellness to provide employers a full menu of wellness program offerings. One of the services is a legal compliance product where Infinisource's Chief Compliance Officer will assist an employer to provide incentives or surcharges in its group health plan that promote wellness and comply with HIPAA. For more information, please go to the Products and Services section of our website: www.infinisource.net.