Are Forced Wellness Incentive Participation Programs Illegal?

While some people are now obtaining health insurance through other means under the Affordable Care Act, most Americans still get their coverage through their employer. As the cost of health insurance premiums continues to rise, more insurers and employers are beginning to offer wellness incentive programs. The general idea is that if you participate in a wellness program, you pay a lower premium. The program is supposed to increase your wellness, decreasing the cost of your medical expenses and thus the cost of your insurance. But now the Equal Employment Opportunity Commission (EEOC) is cracking down on some wellness programs that have gone from being voluntary to involuntary.

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EEOC Files Suit Over Involuntary Wellness Program

Now there are questions as to whether these required programs are even legal. The EEOC filed a lawsuit this August over a wellness incentive program that the agency claims went from being voluntary to being involuntary. According to an EEOC press release, the suit claims a Wisconsin company tried to require an employee to submit to medical exams and medical inquiries about disabilities, and then when she refused to do so, the company fired her. But first they tried to shift the responsibility for paying the entirety of the health insurance premium to the employee, a woman named Wendy Schobert.

The EEOC’s stance is that firing Ms. Schobert violated the Americans with Disabilities Act (ADA), and that when Ms. Schobert raised legitimate complaints about the wellness program, the company retaliated against her by firing her.

Affordable Care Act Rules

The Affordable Care Act, or Obamacare, put some new rules in place regarding these programs. The idea behind the regulations is to protect consumers from unfair practices. Any health-contingent program, that is, one that requires you to be of a certain level of health (like being a non-smoker, for example), must follow three rules according to the Department of Labor:

• Programs must be reasonably designed to promote health or prevent disease. To be considered reasonably designed to promote health or prevent disease, a program would have to offer a different, reasonable means of qualifying for the reward to any individual who does not meet the standard based on the measurement, test or screening. Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.
• Programs must be reasonably designed to be available to all similarly situated individuals. Or, a reasonable alternative means of qualifying for the reward would have to be offered to individuals whose medical conditions make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard.
• Individuals must be given notice of the opportunity to qualify for the same reward through other means. These proposed rules must provide new sample language intended to be simpler for individuals to understand and to increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan or issuer to request it.

It is unclear what the final result will be, but if you’re being forced to participate in some type of wellness program, this may be against the law.

Tell Us What You Think

Do you know someone who has been forced to participate in a wellness incentive to receive health insurance coverage from his or her employer? We want to hear from you! Leave a comment or join the discussion on Twitter.