when applied effectively, it does more than simply shift costs; it more appropriately helps engender greater responsibility on the part of the health plan member for decisions involving lifestyle, health consumption, and cost
concept of consumerism
researches observed that _____ makes up a significant portion of the total cost of health care
preventable illness
- nutrition
- weight control
- physical activity
- cholesterol
- blood pressure
- tobacco use
- safety
- mental well being
examples of modifiable health risk factors
a tool to help focus attention on health risks and to motivate desired behavior changes
incentives
key motivators that employers should use to help their employees adopt and maintain healthier behaviors
- education
- peer pressure
- use of external incentives
wellness incentives can be classified into three categories based on the type of behavior rewarded
- activities
- achievement
- adherence
5 basic requirements that wellness program must meet under HIPAA when wellness incentives are based on health status-related factors
- total reward must not exceed more than 20% of emplyee only coverage
- designed to promote health and prevent disease
- eligible employees must be allowed to qualify for reward once a year
- reward must be available to similarly situated individuals
- plan must disclose a reasonable alternative standard
the two ADA requirements permit under a wellness program prohibited practices (general med examinations)
- any medical records acquired must be kept confidential and separate from personal records
- program must be voluntary
GINA
Genetic Information Nondiscrimination Act (GINA)
Under GINA, group health plans and insurers are specifically prohibited from engaging in:
- restricting enrollment on basis of genetic info
- requesting individuals undergo genetics testing
- requesting genetics info prior to enrollment
includes info about an individual’s genetic tests or the test of family members
“genetic information” under GINA
