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Reimbursement only if employee participates in an employer paid risk assessment?


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Guest matthew222

I don't think so. Mandating participation in a health screening is fairly new in the grand scheme of things. There was an EEOC opinion letter back in 2009 that ruled an employer couldn't do this, however, it was withdrawn. An employer should be ok, but the more invasive the risk assessment (think full biometric screening vs. a questionnaire), the more likely something could bubble up.

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  • 4 weeks later...

I urge that you seek competent legal advice to make sure that you are compliant with HIPAA and any applicable state laws.

Most likely your self insured medical reimbursement plan will be treated as being a group health plan. As a result the HIPAA non-discrimination rules will apply, especially since you are denying coverage totally. A simple rewards type peogram with stated goals might serve you better.

This might help clarify the issue. Note the 2nd and 3rd Questions:

http://www.dol.gov/ebsa/faqs/faq_hipaa_ND.html

George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

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I don't think so. Mandating participation in a health screening is fairly new in the grand scheme of things. There was an EEOC opinion letter back in 2009 that ruled an employer couldn't do this, however, it was withdrawn. An employer should be ok, but the more invasive the risk assessment (think full biometric screening vs. a questionnaire), the more likely something could bubble up.

The EEOC opinion was withdrawn NOT because it determined that this design is okay. In short, the EEOC withdrew the portion of the opinion where it said that a plan design that met HIPAA's requirements would not violate the ADA but it kept in place the portion where it said that conditioning coverage on completing an HRA was impermissible. The EEOC stated that it is not taking a position at this time on what wellness program plan design might meet the requirements of the ADA.

There are a lot of pitfalls and open questions with wellness programs with respect to a wide variety of laws (not just HIPAA) so I definitely second GBurns's suggestion that competent counsel be consulted.

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Also be aware that the health care reform law's preexisting condition rule will kick in on 1/1/2014. Which will make denial of coverage an even more tricky topic.

Kurt Vonnegut: 'To be is to do'-Socrates 'To do is to be'-Jean-Paul Sartre 'Do be do be do'-Frank Sinatra

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Guest matthew222

The employer wouldn't be denying coverage based on a pre-existing condition. They are basing eligibility on whether or not an employee completes an HRA.

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