Prohibits anything in the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, or the Public Health Service Act from being interpreted to prevent any health insurance provider from establishing premium discounts or rebates, or modifying copayments or deductibles, for individuals who participate in a health promotion or disease prevention (wellness) program which meets this Act's requirements.
States that if none of the conditions for obtaining a premium discount, rebate, or other reward for participation in a wellness program is based on an individual satisfying a standard related to a health status factor, such program shall not violate this Act if participation is made available to all similarly situated individuals with respect to a program: (1) that reimburses the cost for memberships in a fitness center; (2) of diagnostic testing that provides a reward for participation not based on outcomes; (3) that encourages preventive care related to a health condition through the waiver of the copayment or deductible requirement under a health plan for costs related to a health condition (such as prenatal care or well-baby visits); (4) that reimburses individuals for the costs of smoking cessation programs without regard to whether the individual quits smoking; and (5) that rewards individuals for attending a periodic health education seminar.
Provides that if any of the conditions for obtaining a premium discount, rebate, or other reward for participation in a wellness program is based on an individual satisfying a standard related to a health status factor, the program shall not violate this Act if specified conditions are met, including that: (1) the reward for the program, together with the reward for other wellness programs regarding the plan that requires satisfaction of a standard related to a health status factor, does not exceed 30% of the cost of employee-only coverage under the plan; (2) the program is reasonably designed to promote health or prevent disease; (3) the plan gives individuals eligible for the program the opportunity to qualify for the reward at least annually; and (4) the full reward under the program is made available to all similarly situated individuals.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3688 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 3688
To encourage programs of health promotion or disease prevention.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 1, 2009
Mr. Arcuri (for himself, Mr. Buyer, Mr. Castle, Mr. Polis of Colorado,
Mr. Donnelly of Indiana, and Mr. Deal of Georgia) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Education and Labor and
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To encourage programs of health promotion or disease prevention.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. PROGRAMS OF HEALTH PROMOTION OR DISEASE PREVENTION.
(a) In General.--Nothing in the Employee Retirement Income Security
Act of 1974, the Internal Revenue Code of 1986, or the Public Health
Service Act shall be applied, administered, or interpreted to prevent
any provider or issuer of health insurance (including any employer)
from establishing premium discounts or rebates, or modifying copayments
or deductibles, in the case of individuals who adhere to, or
participate in, a program of health promotion or disease prevention
which meets the requirements of subsection (b).
(b) Programs of Health Promotion or Disease Prevention to Which
Section Applies.--
(1) General provisions.--
(A) General rule.--For purposes of subsection (a),
a program of health promotion or disease prevention
(referred to in this subsection as a ``wellness
program'') shall be a program that is designed to
promote health or prevent disease that meets the
applicable requirements of this subsection.
(B) No conditions based on health status factor.--
If none of the conditions for obtaining a premium
discount or rebate or other reward for participation in
a wellness program is based on an individual satisfying
a standard that is related to a health status factor,
such wellness program shall not violate this section if
participation in the program is made available to all
similarly situated individuals and the requirements of
paragraph (2) are complied with.
(C) Conditions based on health status factor.--If
any of the conditions for obtaining a premium discount
or rebate or other reward for participation in a
wellness program is based on an individual satisfying a
standard that is related to a health status factor,
such wellness program shall not violate this section if
the requirements of paragraph (3) are complied with.
(2) Wellness programs not subject to requirements.--If none
of the conditions for obtaining a premium discount or rebate or
other reward under a wellness program as described in paragraph
(1)(B) are based on an individual satisfying a standard that is
related to a health status factor (or if such a wellness
program does not provide such a reward), the wellness program
shall not violate this section if participation in the program
is made available to all similarly situated individuals. The
following programs shall not have to comply with the
requirements of paragraph (3) if participation in the program
is made available to all similarly situated individuals:
(A) A program that reimburses all or part of the
cost for memberships in a fitness center.
(B) A diagnostic testing program that provides a
reward for participation and does not base any part of
the reward on outcomes.
(C) A program that encourages preventive care
related to a health condition through the waiver of the
copayment or deductible requirement under an individual
or group health plan for the costs of certain items or
services related to a health condition (such as
prenatal care or well-baby visits).
(D) A program that reimburses individuals for the
costs of smoking cessation programs without regard to
whether the individual quits smoking.
(E) A program that provides a reward to individuals
for attending a periodic health education seminar.
(3) Wellness programs subject to requirements.--If any of
the conditions for obtaining a premium discount, rebate, or
reward under a wellness program as described in paragraph
(1)(C) is based on an individual satisfying a standard that is
related to a health status factor, the wellness program shall
not violate this section if the following requirements are
complied with:
(A) The reward for the wellness program, together
with the reward for other wellness programs with
respect to the plan that requires satisfaction of a
standard related to a health status factor, shall not
exceed 30 percent of the cost of employee-only coverage
under the plan. If, in addition to employees or
individuals, any class of dependents (such as spouses
or spouses and dependent children) may participate
fully in the wellness program, such reward shall not
exceed 30 percent of the cost of the coverage in which
an employee or individual and any dependents are
enrolled. For purposes of this paragraph, the cost of
coverage shall be determined based on the total amount
of employer and employee contributions for the benefit
package under which the employee is (or the employee
and any dependents are) receiving coverage. A reward
may be in the form of a discount or rebate of a premium
or contribution a waiver of all or part of a cost-
sharing mechanism (such as deductibles, copayments, or
coinsurance), the absence of a surcharge, or the value
of a benefit that would otherwise not be provided under
the plan. The Secretaries of Labor, Health and Human
Services, and the Treasury may increase the reward
available under this subparagraph to up to 50 percent
of the cost of coverage if the Secretaries determine
that such an increase is appropriate.
(B) The wellness program shall be reasonably
designed to promote health or prevent disease. A
program complies with the preceding sentence if the
program has a reasonable chance of improving the health
of, or preventing disease in, participating individuals
and it is not overly burdensome, is not a subterfuge
for discriminating based on a health status factor, and
is not highly suspect in the method chosen to promote
health or prevent disease. The plan or issuer shall
evaluate the program's reasonableness at least once per
year.
(C) The plan shall give individuals eligible for
the program the opportunity to qualify for the reward
under the program at least once each year.
(D) The full reward under the wellness program
shall be made available to all similarly situated
individuals. For such purpose, among other things:
(i) The reward is not available to all
similarly situated individuals for a period
unless the wellness program allows--
(I) for a reasonable alternative
standard (or waiver of the otherwise
applicable standard) for obtaining the
reward for any individual for whom, for
that period, it is unreasonably
difficult due to a medical condition to
satisfy the otherwise applicable
standard; and
(II) for a reasonable alternative
standard (or waiver of the otherwise
applicable standard) for obtaining the
reward for any individual for whom, for
that period, it is medically
inadvisable to attempt to satisfy the
otherwise applicable standard.
(ii) If reasonable under the circumstances,
the plan or issuer may seek verification, such
as a statement from an individual's physician,
that a health status factor makes it
unreasonably difficult or medically inadvisable
for the individual to satisfy or attempt to
satisfy the otherwise applicable standard.
(E) The plan or issuer involved shall disclose in
all plan materials describing the terms of the wellness
program the availability of a reasonable alternative
standard (or the possibility of waiver of the otherwise
applicable standard) required under subparagraph (D).
If plan materials disclose that such a program is
available, without describing its terms, the disclosure
under this subparagraph shall not be required.
(c) Existing Programs.--Nothing in this section shall prohibit a
program of health promotion or disease prevention that was established
prior to the date of enactment of this section and applied with all
applicable regulations, and that is operating on such date, from
continuing to be carried out for as long as such regulations remain in
effect.
(d) Regulations.--Nothing in this section shall be construed as
prohibiting the Secretaries of Labor, Health and Human Services, or the
Treasury from promulgating regulations in connection with this section.
<all>
Introduced in House
Introduced in House
Referred to House Energy and Commerce
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Education and Labor
Referred to House Ways and Means
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health, Employment, Labor, and Pensions.
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