Originated by: Robin Vlamis
Submitted: 23 Aug 2012
Last updated on:
23 Aug 2012
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When most people are asked about health care reform, or the Affordable Care Act (ACA), the first thing they think of is the individual mandate. But did you also know there are many other provisions tucked away in the over 2,400 page law that will affect everything from how much you pay for a preventive health visit to what programs health programs may be offered at your workplace? Some of the fairly unknown components of the ACA are changes that affect worksite wellness programs. Many of us know these programs from around our own offices – lunch time walking clubs, signs in the stairwells to promote walking, free bottled water, etc. Well, keep your eyes open, because these programs could be expanding even more in an attempt to get the American workforce healthier and less costly in terms of our medical expenses.
The following are some highlights from the ACA that focus on worksite wellness programs, as well as scheduled dates for implementation:
Employers may offer discounts to employees on their premiums of up to 30% of the total cost of health insurance coverage (with the possibility of going up to 50%) for participation in wellness programs and meeting specific health-related standards. This cap is currently set at 20%. (Note: employees who cannot participate in the program due to health or other restrictions must be given an alternative option.) EFFECTIVE DATE: January 1, 2014
Pilot programs will be established in ten states that will evaluate the success of wellness programs offered through the individual market. So, instead of a program being offered through one’s employer, it would be provided by the health insurance company. If deemed effective, this could be expanded to other states in 2017. EFFECTIVE DATE: Establish pilot programs by July 1,2014
Outcomes and Evaluation
Health insurance companies will need to report on: 1) how they have improved health outcomes through their programs (e.g. case management) and 2) the types of wellness and health promotion activities they offer (e.g. smoking cessation, healthy eating, physical activity, etc). (Note: plans that were in existence in March 2010 are “grandfathered” and therefore exempt from this public reporting requirement.) Having a responsibility to report on these outcomes could mean an increase in wellness programs offered through health insurance companies. EFFECTIVE DATE: Not specifically stated
The federal government will offer technical assistance in order to evaluate employer-based worksite wellness programs. Additionally, a survey of employer-based health policies and programs will be carried out. EFFECTIVE DATE: Study to be conducted within two years of enactment
Small businesses (100 or fewer employees working 25+ hours per week) will be eligible for federal grants to help establish worksite wellness programs. A total of $2 million over five years has been set aside for this. EFFECTIVE DATE: 2011
National Health Awareness Program
The federal government will also create a national health awareness program to educate the public about the importance of health promotion programs, such as those offered in the community and or at the worksite. EFFECTIVE DATE: Upon enactment
Resources for Implementation
There are a variety of resources available to assist with the establishment of worksite wellness programs. The American Cancer Society offers a program called “Workplace Solutions” that provides plans that can be customized for your particular workplace. These evidence-based programs focus on Managing Weight, Quitting Tobacco, and Getting Involved in volunteer efforts. For more information, visit http://www.acsworkplacesolutions.com/index.asp.
Additionally, the Society for Human Resource Management (www.shrm.org) has tools available (some only to members) for ways to strategize and develop worksite wellness programs. An informative summary article on wellness strategies can be found here:
Lastly, the Centers for Disease Control and Prevention has a section on its website titled, “Healthier Worksite Initiative” which provides detailed information on how to develop and implement wellness programs at the workplace. Sample programs are provided on topics such as obesity prevention, lactation support, and establishing wellness committees. The website is: http://www.cdc.gov/nccdphp/dnpao/hwi/index.htm
In most cases, wellness programs currently in existence can continue to operate as they are. Companies interested in any of the new and updated wellness policies should also look to contact their insurance service provider for additional guidance. It is unclear at this point how much assistance the insurance companies will provide in terms of implementation. Most likely, companies will need to budget and plan for these programs from their own pockets, with the possible assistance of federal grants for eligible organizations.
Kaiser Family Foundation. Focus on Health Reform: Summary of New Health Reform Law. http://www.kff.org/healthreform/upload/8061.pdf. Accessed July 14, 2012.
NOLO Law for All. How Health Reform Legislation Will Affect Workplace Wellness Programs. http://www.nolo.com/legal-update/health-reform-legislation-workplace-wellness-33622.html. Accessed July 11, 2012.
Healthcare.gov. The Affordable Care Act, Section by Section. http://www.healthcare.gov/law/full/index.html. Accessed July 11, 2012.