Trump Administration issues guidance on health-contingent wellness programs, including tobacco cessation programs

WASHINGTON - The U.S. Department of Labor announced today that its Employee Benefits Security Administration , along with the departments of Health and Human Services and Treasury, issued guidance related to questions raised in dozens of class-action lawsuits challenging the tobacco surcharges some employers add to premiums for their group health plans through workplace wellness programs.

The Health Insurance Portability and Accountability Act of 1996 and the Affordable Care Act allow employers to reward employees for healthy habits through wellness programs. Wellness programs can cover things like nutrition, weight loss, tobacco cessation, fitness, alcohol and drug abuse assistance, managing stress, or general health education.

The FAQs released today announce the departments' approach to enforcement for health-contingent wellness programs, which are programs that reward an employee if they satisfy a standard related to a health factor. Until further guidance or regulations are issued, the departments will not take enforcement action against plans or issuers that do not give employees the wellness program reward retroactively to the beginning of the plan year after the employee completes a reasonable alternative standard. Under the terms of the enforcement relief in these FAQs, plans and issuers only need to provide the reward prospectively, from the point where the employee completes the alternative standard, if retroactive rewards are not otherwise provided.

The FAQs also address plans' and issuers' disclosure obligations related to health-contingent wellness programs. Specifically, if plan materials merely mention that a health-contingent wellness program is available, without describing its terms, the plan or issuer is not required to disclose the availability of a reasonable alternative standard to qualify for the reward under the wellness program.

"The experimental nature of wellness programs enables them to drive significant and clinically meaningful health maintenance and improvements," said Assistant Secretary for Employee Benefits Security Daniel Aronowitz. "This guidance makes clear to sponsors and issuers that, as long as they are offering reasonably designed, and otherwise non-discriminatory wellness programs, they will not be penalized for wanting to help motivate the people they cover to make efforts to improve their health."

Employers and workers can contact EBSA at askebsa.dol.gov or call 866-444-3272 toll-free for help with private sector job-based retirement and health plans.

Read the FAQs on wellness programs in employer-sponsored health plans .