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Wellness Plan Compliance Audit

For many employers, the wellness plan plays a valuable and strategic role in helping to contain health coverage costs. In addition to promoting a healthy and productive workforce, the wellness plan encourages employees to take a proactive approach to preventing disease and promoting health. HIPAA nondiscrimination rules have allowed limited premium discounts or rebates in exchange for a participant’s adherence to specified wellness program provisions. The Affordable Care Act (ACA) significantly expanded these incentives, offering employers an increased ability to manage costs while promoting healthier employee populations.

However, in order to avoid intentional and unintentional discrimination in the application of wellness incentives, an employer’s plan must be carefully designed and implemented. There are generally four common types of wellness programs: general educational or participation-only (not health plan related), participation-only (health plan related), activity-only (health plan related), and outcome-based (health plan related).

Common Types of Wellness Plans
Not Health Plan Related Health Plan Related
Participation Only Participation Only Activity Only Outcome Based

Knowing what type of wellness program an employer has is important in determining which federal laws apply or do not apply. Some of the federal laws that may apply are listed below.

Medcom Benefit Solutions thoroughly reviews and evaluates the wellness plan, including all relevant documentation, premium contributions and incentives, and enrollment materials, to identify all areas that are discriminatory or non-compliant. Our Wellness Plan Compliance Report confirms the plan’s status in relation to all current federal wellness plan requirements and provides recommendations for achieving compliance for those areas that are found to be non-compliant. With this evaluation, an employer will be confident in administering a highly beneficial and fully compliant program that adheres to federal regulations.

Federal Laws That May Apply

  • Age Discrimination in Employment Act (ADEA)
  • Americans with Disabilities Act (ADA)
  • COBRA
  • ERISA
  • Fair Labor Standards Act (FLSA)
  • Genetic Information Nondiscrimination Act (GINA)
  • HIPAA and HIPAA Nondiscrimination Laws
  • Internal Revenue Code Tax Laws
  • Mental Health Parity and Addiction Equity Act (MHPAEA)
  • Patient Protection of the Affordable Care Act (PPACA)
  • Title VII of the Civil Rights Act

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