Do I Have to Participate in Employer Wellness Programs?
My employer is requiring that we participate in a bio-metrics screening for a wellness program. I do not need to give my results, I just need to participate. They call it a “know your numbers” program. They pay for the screening and it is being held at our office with an outside organization doing the tests. My employer contributes towards the cost of our medical plans.
If I choose not to participate, I will have to pay the entire premium with no contribution by my employer. Does this make my plan unaffordable where I may be eligible for a subsidy based on my income?
Answer
If an employer offers a wellness program and you don't participate, and thus your premium is "unaffordable" you can use the Marketplace. This is also true if your cost sharing amount would be greater than the average of the 60% minimum. In more specific terms if premiums would cost more than 9.56% of income for self-only coverage or if actuarial value (average amount paid by plan) would be less than 60% an employee can have an employer fill out an employer coverage tool and can use the Marketplace.
This is a roundabout way of getting Marketplace coverage, but from what we understand it would work. This PDF is probably the best resource we have found on unaffordable coverage, so check it out for more details.
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What about the employers – if employers create and sustain wellness plans it seems, according to research I have done (see one of my sources here:
https://www.dol.gov/ebsa/newsroom/fswellnessprogram.html), there is some sort of discount they can receive on healthcare premiums. Yet no one I talk to seems to know anything about it – do you have any information?
So it was a proposed rule, and i’m pretty sure it got passed as part of a bulk update to the law a few years back. I can look into more, but think this page should have some of the answers you are looking for: http://kff.org/private-insurance/issue-brief/workplace-wellness-programs-characteristics-and-requirements/