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Healthcare & Benefit Services News :: Special Health Care Reform Update: New Proposed Rules for Wellness Programs

New proposed rules issued under Health Care Reform address certain amendments to the nondiscrimination requirements for group health plans offering a wellness program to comply with the federal Health Insurance Portability and Accountability Act (HIPAA).

Specifically, the proposed rules would increase the maximum permissible reward under a wellness program that requires an individual to satisfy a standard based on a health factor in order to obtain a reward, from 20% to 30% of the cost of coverage (and to 50% for programs designed to prevent or reduce tobacco use). The rules also include other proposed clarifications regarding the requirements for such wellness programs to avoid prohibited discrimination, including reasonable design and reasonable alternatives that must be offered for individuals to obtain the reward.

Other Proposed Rules Released Under Health Care Reform
Separately, new proposed rules have been issued for health insurance companies regarding the law’s requirements related to guaranteed availability of coverage and essential health benefits.

  • Under one set of proposed rules, issuers offering non-grandfathered health insurance coverage in the individual or group market would be required to accept every individual and employer that applies for coverage, with limited exceptions. Issuers in the individual and small group markets would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.
  • Another set of proposed rules outline issuer standards related to coverage of “essential health benefits.” Essential health benefits are a core set of items and services that must be covered by non-grandfathered plans in the individual and small group markets beginning in 2014.

The new proposed rules would apply for plan years beginning on or after January 1, 2014. An overview of the proposed rules is available on Our Summary by Year offers updates on other requirements related to Health Care Reform.

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