Wellness Programs and Health Care Reform

Offered by workplaces, wellness programs are designed to promote healthy lifestyle choices, and lead to more productive lives and better well-being of participants. They are also intended to reduce the cost of health care.


The Department of Health and Human Services, Department of Labor and Department of the Treasury together released rules to encourage businesses to offer wellness programs, and to protect consumers from unfair practices. They will go into effect January 1, 2014 along with the Affordable Care Act. Two kinds of programs were defined: participatory, and health contingent.

Participatory programs are available to anyone and include, for example, reimbursement for a gym membership, or a reward for taking a physical evaluation without a requirement to do anything further. Health-contingent programs might offer rewards to people who meet fitness goals, quit smoking or have other measurable results. Some of the new health contingent program rules are as follows:

  • The program must be designed to promote health or prevent disease. For those individuals who fall outside the standards for measurements or tests, an alternate goal must be offered.
  • If an individual has a medical condition, the program must offer a reasonable alternative method of meeting a goal in order to receive a reward.
  • In these types of situations, the modifications offered must be communicated clearly to the participant, and the program administrator may work with the participant’s physician to formulate reasonable alternatives.

The new rules also include more flexibility for employers:

  • The maximum permissible reward under a wellness program is increased from 20% to 30% of the cost of health care premium for a given employee. For tobacco cessation programs, the reward can be up to 50%.

You can read the complete final rules and regulations here.

Wellness programs have proven to potentially improve overall health and well being, provide education about fitness and nutrition, help ensure people get check-ups, immunizations and follow up care, and reduce health care spending.