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Wellness Program — Notice of Reasonable Alternative Standard

Discloses that a reasonable alternative standard is available to earn the wellness reward. Include in all materials describing a health-contingent wellness program.

Companies Eligible

Health-contingent wellness programs: the reward depends on meeting a health standard (activity-only or outcome-based — BMI, cholesterol, tobacco-free).

Participatory programs, where the reward is for completing an HRA or screening regardless of the result, do not need it.

What it is

Under the HIPAA nondiscrimination rules, program materials must tell participants that a reasonable alternative standard (or a waiver) is available to anyone for whom the standard is unreasonably difficult or medically inadvisable, and give a contact. The reward is limited to 30% of the total cost of coverage (50% where tobacco is involved), the program must be reasonably designed, and everyone must get a chance to qualify at least once a year.

What needs to be done

  • When: In every plan material that describes the program terms. For outcome-based programs, also in any notice telling an individual they did not meet the standard.
  • To whom: Everyone eligible for the program.
  • Who performs: Employer or the wellness vendor.
  • Customize: Program description, the contact for requesting an alternative, and the physician-recommendation language.
  • Deliver: With the program materials and results notices.
  • Keep: Program materials by year and a log of alternatives granted.

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