A non-smoker is healthier than a smoker. Chronic ailments are less likely to affect those who exercise often. Disease screening reduces disease prevalence. All of these facts are true, generally speaking - preventative health measures reduce illness and health care needs in the future, which is why starting in 2014, employers in the United States will have even more opportunity to offer workers reduced insurance costs for proving that they are taking control of their own health, and engaging in programs to improve physical wellness.
American employers have for many years offered monetary incentives to workers who can prove they are taking steps to become healthier. In 2012, Kaiser Health News reported on the Swiss Village Retirement Community in Berne, Indiana. It is a company which offers employees lower annual deductibles for participating in wellness programs; for some workers, the cost of health insurance may be reduced by as much as $2,000 per year. In return, workers must undergo a health check-up, knowing that the results of these tests will be released to their employer. If a worker can prove that he does not smoke, is not obese and has appropriate levels of cholesterol and blood pressure, financial benefits will follow.
Similarly, at the real estate firm Jones Lang LaSalle, workers who pledge not to use tobacco, to attend a non-smoking class or to work toward a healthy weight can receive insurance premiums of 10 percent lower than normal. The firm also offers cash incentives to encourage employees to undergo health screenings: $250 for taking four tests in weight, blood pressure, glucose and cholesterol. As in many companies, Jones Lang LaSalle will also give these financial incentives to spouses and dependents who share an insurance plan with a Jones Lang LaSalle employee.
This week, workplace wellness programs were again in the news with an announcement by the Obama administration that starting in 2014, employers will have even more possibilities to offer these programs to workers. According to the new rules released by the administration, employees who join a wellness program may soon be able to have their insurance costs reduced by 20 to 30 percent, or as much as 50 percent if the employee engages in a stop-smoking program.
Under federal legislation, a workplace wellness program falls under one of two categories: a participatory program, or a health-contingent program. A participatory program may mean attending a no-cost health seminar, or joining a gym at reduced costs - any program offered through the workplace that gives employees a financial incentive to complete a healthy activity. Importantly, the end result of a participatory program will not be evaluated, and a worker will not receive more or less money based on how well they perform - participation is the only requirement.
A health-contingent wellness program, on the other hand, is much more outcome-based. Examples of health-contingent programs include rewarding employees who do not smoke, and offering incentives to workers who undergo tests and can prove that they do not suffer from chronic disease risk factors such as obesity or high cholesterol.
Of these two types of wellness programs, health-contingent ones are by far the more controversial. There is much concern that health-contingent programs discriminate against employees with genetic dispositions toward health problems; making these workers pay higher insurance premiums than their naturally healthier office colleagues. The ability to lose weight, for example, is in part determined by genetics and environment; therefore, it may be discrimination if an employer offers lower insurance premiums to workers who achieve a healthy weight more quickly.
Then again, federal wellness program regulations are designed to avoid discrimination; in fact, the ruling filed this week by the Department of Health and Human Services is entitled: Incentives for Nondiscriminatory Wellness Programs in Group Health Plans. Although these final rules do offer employers more changes to engage their workers in wellness programs, the rules also create measures to keep these programs fair. For example, the rules state that all employees must be allowed to participate in the same wellness program, and have the opportunity to reap the same benefits. If an employee is unable to participate in a program (perhaps she has a broken leg and cannot attend an office field day), the onus is on the employer to provide an alternative wellness program.
Besides the issue of discrimination, there is also concern that some workplace wellness programs could lead to privacy violations. With health-contingent wellness programs especially, an employee is required to share what might be sensitive health information with bosses in order to receive financial benefits. Although some workers may be comfortable making medical test results public, other workers may feel that they should not be asked to share such personal information. In fact, one employee of Broward County, Florida, sued his employers in 2010 for asking workers to fill in a health information for and take a short blood test every year. The employee, Bradley Seff, has argued that it was a violation of privacy to require such information. Employees of the county who did not participate in the health assessment were made to pay a $40 fine.
Although it seems obvious that wellness programs would lead to better health and lower insurance costs for all, research has proved inconclusive. A study this March of 800 businesses around the United States found that more than 80 percent of these companies were offering some sort of incentive-based wellness program to workers; however, there were few major changes in health care costs. But then again, wellness programs have no effect on catastrophic health problems or injury, and so it is difficult to say to what extent the programs do or do not improve workplace health or influence the cost of insurance.