CEBS: GBA 1, Module 8
3 Keys benefits of a workplace wellness program
(1) Fewer absences. (2) Improved productivity. (3) Worker satisfaction and retention.
6 key ingredients that typically comprise a well-structured wellness program
(1) Health screenings. When designing a workplace wellness program, it is important to establish a baseline measurement of employees' current state of health and a profile of their health-related behaviors. Two useful tools can accomplish this: (a) Health risk assessment (HRA): The health risk assessment is a confidential form, most often prepared and administered by an outside vendor, that employees fill out, answering questions about their health-related behaviors— everything from whether they wear seatbelts to whether they exercise regularly. After completion of the HRA, an employee is given a private report, summarizing the results and making recommendations for improved health. When potential problems are revealed—such as a regular smoker mentioning that exercise is too difficult because of constant fatigue and coughing—the HRA will not attempt to deliver a diagnosis. What it will do is encourage every employee to obtain preventive health services and possibly make individual recommendations to see a doctor, if someone's symptoms suggest a deeper problem. (b) Biometric testing. For more detailed health status results, many employers bring in a nurse or other qualified professional to collect "biometrics"—test results for blood pressure, body fat percentage, cholesterol levels and other risk factors. This information is gathered via various physical measurements as well as a blood sample (usually done through a finger prick). Though biometric tests are not diagnostic, they have been shown to be very effective at motivating employees to get necessary medical attention or sign up for health-related activities to improve their results. (2) Educational and self-help tools. Employers can help to ensure that their employees get the most accurate, up-to-date health news to dispel confusion and misperceptions. To get peoples' attention, employers will probably want to use a combination of formats. Popular choices include targeted e-mails or websites, printed newsletters and short seminars (i.e., "lunch and learns") with guest speakers. The idea is to give people multiple ways to encounter company health messages. Videotaping speakers is a good idea, too; that way, people who miss the talks can watch them later. As far as subject matter, a company's health education program might provide, for instance, recommendations on target heart rates and water consumption, summaries of reports and studies (for example, those linking smoking and obesity to certain diseases), healthy recipes and much more. There's no need to stick to straight health topics, either: Discussions about living a balanced life and tips on dealing with financial difficulties are also relevant to total wellness and may be included, depending on the company's culture. GBA 1 | Directing Benefits Programs Part 1 Workplace Wellness Programs | Module 8 Module 8 | 9 (3) Organized activities. Most wellness programs include some visible activities— often on site—that employees can actively join, such as group walking or backsafety classes. Employers can decide what activities to include based on various factors: employee interest, employee health needs, and ideas offered by a wellness team. (4) Individual followup and treatment. If a number of employees are affected by a certain condition or habit, there is nothing wrong with holding on-site classes or other group activities especially for them. Such classes could focus on how to manage a particular chronic illness or live a healthier lifestyle—covering nutrition and stress management. (5) Incentives. Incentives and rewards—cash, movie tickets, discounts on medical care or gifts—have been shown to double worker participation. Many employers use a small incentive right at the start, to motivate people to take an initial health screening. What is "small"? Think cash or cash value of $25 to $50. After that, employers might offer incentives for meeting short-term goals—for example, they might give something to everyone who walks ten miles or more within a two-week period. They might also offer more for longer term achievements— for example, to whoever accrues the most fitness points over a six-month period. (6) A supportive environment. If a company provides one message in its wellness materials but fails to follow through or provides contrary messaging through other actions, its employees will assume the wellness program is not taken seriously and is not a corporate priority. If, for example, the company is encouraging people to bike to work, it will need to have secure bike racks in place. This attention to detail must extend from top management down throughout the organization. If the chief executive officer (CEO) looks suspiciously at everyone who comes in late—despite the fact that they were at the gym, and the company provides flex time for this—its program will not flourish. Conversely, a CEO who stops smoking and invites people to go jogging during the lunch hour will motivate people more than any pamphlet or statistic ever can.
major wellness program policy objectives Made by EEOC, responsible for monitoring ADA & GINA compliance
(a) ADA and GINA standards for wellness programs. • In 2000, the EEOC issued enforcement guidance that a wellness program is considered voluntary under the ADA "as long as an employer neither requires participation nor penalizes employees who do not participate." In 2010, final regulations to implement GINA restated this definition of voluntary wellness programs. • In 2014, EEOC brought enforcement actions against several employers that penalized workers who would not participate in wellness programs that included medical inquiries. One action involved an employer that used financial incentives to encourage participation. Employer groups expressed disagreement with these actions, urging that ADA should be interpreted to permit use of financial incentives similar to those authorized under ERISA/ ACA. (b) ADA standards for wellness programs offered through a group health plan. • In May 2016, EEOC issued final rules on regulations to reinterpret ADA standards for voluntary wellness programs. The rules require any wellness program that involves medical inquiries to be reasonably designed, as defined under the ERISA/ACA rule. The ADA rule also specifies a reasonably designed wellness program must not be designed mainly to shift costs onto employees based on their health. And if the program collects health information it must also provide participants with their results, followup information, or advice designed to improve health or use collected information to design a program that addresses at least a subset of health conditions identified. • In addition, two new standards relating to (1) financial incentives and (2) notices apply to wellness programs. (1) With respect to incentives, employers cannot deny eligibility for group health plan benefits or take adverse employment action, or retaliate against, intimidate, or threaten employees who refuse to participate in workplace wellness programs. The rule allows use of financial incentives or in-kind incentives to promote employee participation in wellness programs that include medical inquiries. The maximum financial incentive is 30% of the total cost (employer and employee share) of self only group health plan coverage. The rules specify this limit applies to both health-contingent and participatory wellness programs. A wellness program is considered voluntary under ADA if the amount of an incentive offered for participation—alone or in combination with incentives offered for health-contingent wellness programs—does not exceed this maximum. The rule further specifies that incentives need not be conditioned on participating in the group health plan. For example, if an employer offers a wellness program but does not offer group health plan benefits, the maximum incentive will be determined using the cost for self-only coverage meeting certain criteria sold on an ACA marketplace. Finally, the rule specifies that wellness programs cannot condition the incentives on the individual's agreeing to the sale, exchange, sharing, transfer, or other disclosure of medical information or to waive confidentiality protections that would otherwise apply. (2) Notice requirements also apply to wellness programs that involve medical inquiries such as HRAs. Programs are required to provide workers notice of what information will be requested, how it will be used, and how the privacy and security of personal information will be protected. Notice requirements also apply to any workplace wellness program, either health-contingent or participatory, that involves medical inquiries. (c) GINA standards for wellness programs. • In May 2016, EEOC issued a final rule to make similar changes in workplace wellness standards under GINA as under the ADA. The GINA wellness rule addresses the extent to which an employer may offer inducements to an employee's spouse to participate in its workplace wellness program. Inducements for the spouse to participate in a wellness program can be made without regard to whether the employer offers group health benefits to the spouse or whether the spouse participates in the employer's group health plan. Under GINA, genetic information is defined to include not only results of a genetic test, but health information about an individual's family members, including the spouse. The rule makes an exception to this definition and permits wellness programs to offer incentives to spouses to provide information about their own health status, though not about results of genetic tests. The rule does not permit workplace wellness program to offer incentives for children of employees to disclose their genetic information or any other health information. • The GINA wellness rule adopts the ERISA/ACA definition of a reasonably designed wellness program as modified by the ADA wellness rule. • In addition, the GINA wellness rule amends the standard for voluntary wellness programs to permit a maximum incentive for the spouse to participate in the workplace wellness program. The maximum incentive applicable to the spouse would also be 30% of the cost of self-only coverage offered by the employer, regardless of whether the spouse participates in the health plan. If the employer does not offer a health plan, the rule specifies the type of ACA public exchange plan on which to base the maximum incentive. The rule also includes the ADA rule requirement that wellness programs cannot condition incentives on individuals agreeing to the sale, exchange, sharing, transfer or other disclosure of their genetic information.
federal privacy standards that are applicable to workplace wellness programs
(a) Federal privacy protections may also apply to personal information gathered under workplace wellness programs. The ADA establishes privacy standards for covered entities subject to that law, that is, employers with 15 or more workers. Covered employers are required to keep private all medical information about workers that they may obtain, whether such information is collected through a wellness program or gathered for other permitted employment-related purposes. Access to identifiable medical information is restricted and only need-to-know exceptions are allowed, such as for administering a health plan. Identifiable medical information must be kept securely and separate from other employment records. With respect to employer wellness programs, the EEOC rule reiterates that medical information obtained by the program may only be provided to the employer in aggregate terms that do not disclose or are not reasonably likely to disclose the identity of any employee. In case of a suspected violation of ADA privacy rules, individuals may file a complaint with the EEOC and/or initiate a private lawsuit. Similar privacy standards under GINA apply to genetic information. (b) Federal privacy protections under HIPAA also apply to some workplace wellness programs. Covered entities under HIPAA include most health care providers, health care clearinghouses and health plans, including group health plans sponsored by employers, but employers are not covered entities under HIPAA. As a consequence, HIPAA privacy rules do not apply to wellness programs that are offered directly by employers outside of a group health plan. Under HIPAA, a group health plan generally cannot disclose personal health information to a person's employer without that person's authorization, but a group health plan is permitted to disclose protected health information to the employer without authorization if the employer certifies to the plan that it will safeguard the information and not use or share it for any employment-related activity or in connection with any other benefit. In case of a suspected violation of HIPAA privacy rules, individuals may file a complaint with the U.S. Department of Health and Human Services (HHS); there is no private right of action under HIPAA. For a complaint involving a covered workplace wellness program, HHS would investigate and verify whether the plan had received the required certifications from the employer. If the group health plan had not obtained the required certification, HHS could seek civil monetary penalties. However, if HHS found that an employer had violated its promise to only use the information that it receives for permitted purposes, HHS could not pursue enforcement against the employer due to the agency's limited jurisdiction. (c) Interpretive guidance issued with the final ADA wellness rule notes that different privacy standards might apply to worksite wellness programs, depending on whether or not the program is offered as part of a group health plan. Under the EEOC rule, privacy standards established under the ADA will continue to apply to any ADA covered entity. In addition, when a wellness program is part of a group health plan, its obligation to comply with ADA privacy rules will likely be satisfied by adhering to HIPAA privacy rules. (d) Under all three privacy standards, it is permissible for wellness programs to share participants' health information with their business partners for purposes of administering the program. Under the "reasonably designed" standard, for example, this could include sharing information with a business partner to market health-related products and services to the enrollee. In summary, the May 2016 EEOC rules for ADA and GINA supplement existing wellness regulations under HIPAA/ACA and, in some cases, compliance with HIPAA/ACA does not guarantee ADA and GINA compliance. Specifically, HIPAA/ ACA rules do not impose any incentive limitation on "participatory" wellness programs, while ADA and GINA rules do impose limits if such programs include health risk assessments (HRAs) or biometric testing. In addition, HIPAA/ACA rules apply only to those wellness programs offered with group health plans; ADA and GINA rules also apply to wellness programs that are "self-standing." That is, the final EEOC rules make it clear that for purposes of ADA and GINA, there is no distinction as to their applicability between wellness programs offered inside or outside of group health plans.
Prevalence of health-contingent programs
A small percentage of programs offered by employers today are health-contingent wellness programs as authorized under the ACA. In 2015, 5% of large employers that offer health plans and wellness programs included financial incentives for participants to complete biometric screening and meet one or more biometric outcomes. Most often in such large firms, biometric outcomes relate to blood pressure (93%), body mass index (87%), blood cholesterol (85%), and blood glucose (67%) levels. About 5.1 million covered workers are at large firms offering health-contingent wellness programs. When such programs are offered, most large employers use more limited financial incentives than the maximum permitted under the ACA. In most (51%) health-contingent wellness programs offered by large employers in 2015, the financial incentive is $500 or less, though in 29% of such programs, the reward or penalty exceeds $1,000.
key decisions when designing a workplace wellness program
Among these decisions are the following: (a) Who is the program being designed for? Generally a workplace wellness program should not be designed targeting the most fitness-conscious employees who are already pursuing a highly health conscious way of life. Although these employees can be inspirational in motivating some of their co-workers, a workplace wellness program should primarily address the workplace demographic that has struggled with health or wellness issues and is interested in taking positive steps toward better health and improved fitness. (b) Which health issues to address? When designing an initial workplace wellness program, thoughtful consideration should be given to program objectives. Generally, program objectives encompass two key areas: • Promoting a healthy lifestyle for all • Targeted responses to actual health risks and conditions facing current employees. Both of these key areas are important, since living a healthy life improves practically every health risk or condition—But some conditions are inevitably in need of more treatment than simple lifestyle changes can provide.
How are incentives changing as workplace wellness programs?
As employers expand their programs to include additional elements of well-being, they are moving away from outcomes-based incentives—dependent on achieving certain goals—in favor of incentives awarded for program participation. The number of employers using outcomes-based incentives is expected to drop from 44% in 2015 to 24% in 2016, the survey revealed.
Range of incentives offered in workplace wellness programs
Employee participation in workplace wellness programs generally has not been very high. To encourage participation, in 2015, 11% of employers offering health benefits offered incentives for employees to complete an HRA, complete biometric screening or participate in a wellness program related to tobacco use, weight loss or coaching. Large firms offering health benefits are more likely (46%) to use financial incentives than smaller firms (11%). Most large firms with wellness incentives (65%) offer incentives in the form of cash, gift cards or other merchandise. Some provide incentives through health plan premium or cost-sharing discounts (34%) or other incentives such as paid time off (19%). In all, about 24.1 million covered workers are in large firms that offer a financial incentive to participate in the wellness program, and 29.7 million covered workers are in large firms that offer a financial incentive to participate and/or to complete health risk assessments or biometric screening. At firms that offer an HRA, on average about half of employees complete it (51% of employees in small firms, 45% in large firms). Sixty-two percent of large firms offering health risk assessments (or 31% of all large-firm wellness programs) offer financial incentives to employees who complete the health risk assessment. Large firms that offer incentives to complete health risk assessments, collectively, employ about 24.4 million covered workers. Half of large employers that have an incentive to complete an HRA award employees through health plan premium and/or costsharing discounts. Five percent of large-firm wellness programs that offer health risk assessments require employees to complete the assessment in order to enroll in the health plan. Fifty-six percent of large firms offering biometric screening (or 28% of all large-firm wellness programs) offer financial incentives to employees to complete the biometric screening. Forty-seven percent of large employers that offer biometric screening also offer incentives to complete it that are tied to the health plan premium and/or cost sharing, and 7% of large-firm wellness programs that offer biometric screening require employees to complete screening in order to enroll in the health plan. Twenty-one percent of large firms offering health benefits have an incentive for both biometric screening and health risk assessments. In total, 39% of large firms offering health benefits offer incentives for either screening. Among large firms offering financial incentives to participate in workplace wellness programs (including incentives to complete HRAs or biometric screening), the maximum value of financial incentives is $500 or less in 64% (or 19% of all large firms offering health benefits) and is greater than $1,000 in 15% of firms (or 5% of all large firms offering health benefits).
Health-contingent wellness programs
In 2010, the Affordable Care Act amended ERISA to permit group health plans to adopt wellness program incentives that vary a person's group health plan premiums or cost sharing based on their health status. Such programs are called "healthcontingent" wellness programs. Some health-contingent programs provide rewards, such as premium discounts, to people who can meet certain health outcomes, such as normal weight or blood pressure. Others might identify people with health problems and then provide rewards if they participate in wellness classes or activities. In 2013, the Department of Labor (DOL) said health-contingent wellness programs can vary group health plan premiums or cost sharing based on health status and will not be considered to discriminate based on health status if they meet certain standards. Among these conditions are the following: (1) The reward amount is limited. (2) The maximum reward is 30% of the total cost (both the employer and employee share) of self-only group health plan coverage. (3) The maximum can be increased to 30% of the cost of family coverage if spouses and dependents are eligible to participate in the wellness program. (4) The maximum can be further increased to 50% if tobacco-related components are included in the wellness program. (In 2015, the average annual cost of group health plan coverage was $6,251 for an individual and $17,545 for a family. Variation around the average is substantial; for example, 25% of covered workers are enrolled in plans that cost more than $7,000 for single coverage and $20,000 for family coverage. As a result, the maximum wellness incentive could reach thousands of dollars.) Health-contingent wellness programs also must be reasonably designed to promote health or prevent disease. "Reasonably designed" is defined as having a reasonable chance of improving the health or preventing disease, not being overly burdensome or a subterfuge for discrimination, and not being highly suspect in the method chosen to promote health. By regulation, this is "intended to be an easy standard to satisfy . . . There does not need to be a scientific record that the method promotes wellness to satisfy this standard." In addition, reasonably designed health-contingent wellness programs must meet other standards related to providing notice to participants, providing waivers or alternative ways for participants to earn rewards, and making rewards available to participants at least annually. ERISA standards are different for participatory wellness programs. Under the DOL rule, wellness programs that do not base rewards or penalties on health status are called "participatory" wellness programs. Participatory wellness programs are not required to meet any of the five standards that apply to health-contingent wellness programs and generally are not considered to implicate ERISA nondiscrimination rules. However, the DOL rule notes that other employment discrimination laws, such as ADA and GINA as noted in the next question regarding EEOC rules, also apply and that being in compliance with the ERISA/ACA wellness program standards does not relieve employers from having to comply with other federal laws.
Millennial workers differ from that of Baby Boomers regarding financial concerns
Just under half of Millennial workers (44%) say they want their employer to help them address their financial concerns, a response more than double that of Baby Boomers (20%), according to MetLife's 14th Annual U.S. Employee Benefit Trends Study, released in 2016.
Total well-being programs
More employers are investing in "total well-being" programs that address areas such as financial fitness, stress reduction and emotional resiliency, according to the results of the 7th Annual Corporate Health and Well-Being Survey. Survey results are tabulated representing large U.S. employers and include 71 Fortune 100 companies. The findings reveal that predominantly large U.S. employers are adding programs that help employees manage stress, improve their resiliency and assist with their financial challenges. For example, the survey found that: (a) Student loan repayment assistance is being offered by 13% of respondents, and another 21% are considering adding it in the future. (b) Financial education or counseling is provided by 76% of respondents. (c) Emotional or mental well-being programs are offered by 87% of respondents
Stress management
Stress management is by far the most popular emotional well-being program being offered by large employers: 54% of large employers currently offer this program, and an additional 12% are planning to do so in 2017. Also popular is resiliency training, which helps employees manage setbacks in the workplace or in life outside of work: 27% of employers offer this program, with another 20% planning to do so in 2017.
Privacy standards for workplace wellness programs
The Health Insurance Portability and Accountability Act (HIPAA) establishes standards to protect the privacy of personal health information, including information that may be collected by some workplace wellness programs. The ADA and GINA also include certain privacy protections.
affordability factor of wellness plans
The affordability factor associated with wellness programs does not restrict their introduction solely to larger organizations. In fact, many small and mid-sized businesses have been shown to be superior at creating a culture of wellness within the workplace. Also, there are many wellness initiatives that can be introduced for free which do not require the expenditure of monetary resources. Amongst possible free initiatives are the following: (a) Holding regular workplace stretch breaks (b) Organizing a walking program (often cited by employees as their favorite wellness activity) (c) Instituting policies against smoking at work (d) Organizing potluck lunches featuring healthy foods (e) Identifying on-site assets available for wellness programs (such as a nearby walking trail or a conference room suitable for wellness classes).
RAND Study on Wellness Programs
The federal government contracted with the RAND Corporation to describe the design of workplace wellness programs and review their experience achieving cost savings and health status improvements, as well as the experience of programs that use financial incentives and how incentives affect participation rates. The RAND Study identified configurations of workplace wellness programs, based on whether and the extent to which programs offer three types of services: (1) screening to identify health risks, (2) lifestyle management services to reduce risks through encouraging healthier behavior and (3) disease management services to support people who already have chronic conditions. It found that roughly half of all employer wellness programs are limited in the extent and nature of services they offer. Twenty percent of programs focus primarily on health screening and offer limited other wellness activities, while 34% are limited in screening services in addition to other wellness services and interventions. Only 13% of programs were characterized as comprehensive, offering extensive screening, disease management and other lifestyle wellness services.
primary goal of a wellness program
The primary goal of a workplace wellness program is to transform your workplace culture into one that promotes healthy living. In pursuit of this goal, certain initial key decisions should be made.
Prohibitions against discrimination based upon health status
Three federal laws directly address workplace wellness programs within the context of other broad rules that prohibit discrimination based on health status. 1. ERISA 2. ADA 3. GINA The Employee Retirement Income Security Act (ERISA) prohibits discrimination by group health plans based on an individual's health status. ERISA makes exceptions for wellness programs to offer premium or cost-sharing discounts based on an individual's health status in certain circumstances. The Americans with Disabilities Act (ADA) prohibits employment discrimination based on health status and generally forbids employers from inquiring about workers' health status but makes an exception for medical inquiries that are conducted as part of voluntary wellness programs. Finally, the Genetic Information Nondiscrimination Act (GINA) prohibits employment discrimination based on genetic information and forbids employers from asking about individuals' genetic information, including information about family members' health status or family history. Like the ADA, GINA allows an exception for inquiries through voluntary wellness programs.
Financial wellness and emotional well-being
To help employees manage their financial well-being, almost three-quarters (73%) of companies surveyed offer on-site financial seminars, and 59% make a financial coach available to employees. Efforts are being made to integrate financial and emotional well-being, social connectedness and job satisfaction with their more traditional efforts to support physical health. These holistic approaches to well-being play an important role in employee engagement. Over the last decade, research has shown that high stress in employee populations has increased dramatically. Because high stress leads to other health and emotional issues, employers are more determined to address stress in the workforce. Improving resiliency/reducing stress is among the top five behaviors employers say they are focused on in 2016.
primary cost drivers when introducing a wellness program
When designing a wellness program, certain elements comprise the largest drivers of cost. The most significant drivers of cost tend to be for incentives, equipment and outside service providers like consultants, counselors and gyms. The key is to formulate a budget in advance and then to see the level of program offerings that can be facilitated with allotted resources. Sharing certain costs with employees is a popular strategy for small businesses, particularly for things like classes and memberships.
"normal" cost range per employee per year for an employer to sponsored workplace wellness program
the normal range for workplace wellness programs typically ranges from $0 to $450 per employee, per year.
