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Disease Management Plan Design


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If an employer needs / desires to limit number of participants in a newly designed disease management program providing benefits to employees diagnosed with heart disease or hypertension, could the employer:

1. Limit participation in the program to a maximum number of participants at any one time on a "first come, first served" basis such that not all similarly situated employees (i.e., employees diagnosed with hypertension or heart disease) are treated the same?

2. Impose a minimum age requirement (e.g., 50+) as a way of further concentrating the benefits of the program [or further limiting eligibility]?

If there is an issue under ADEA or otherwise with excluding some otherwise eligible participants based solely on age (e.g., employees aged 40-49), could you possibly address the ADEA issue by dropping the minimum age down to 40 such that you were still favoring older employees (reverse discrimination?) but not excluding anybody 40+ protected by the ADEA?

Thanks

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  • 5 weeks later...
Guest matthew222

on the surface this sounds problematic. i would check with a disease management vendor directly for guidance on this.

one question i would have is why would the employer want to limit participation? if someone is implementing a disease management program, they believe that there's a ROI by doing so. and while i can see this figure being greater for someone who's 52 with heart disease vs. 41, i would think there's still benefit with the latter individual.

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