1. Free Legal Help, Legal Forms and Lawyers. TheLaw.com has been providing free legal assistance online since 1995. Our most popular destinations for legal help are below. It only takes a minute to join our legal community!

    Dismiss Notice

Forced Wellness Program Participation or Face Surcharge

Discussion in 'Employee Benefits, Pensions' started by HenryDog, Jun 23, 2015.

  1. HenryDog

    HenryDog Law Topic Starter New Member

    Messages:
    1
    Likes Received:
    0
    Trophy Points:
    0
    The facts:
    My employer has a third party administrator (TPA) that has a wellness program that they (my employer) contracted them to administrate. This program has been revealed (this information was not disclosed to the employees during open enrollment) to review any and all submitted bio-metric screening and all of the participants medical claims that the TPA has processed. This program was instituted 1/1/2015. Based on the TPA statistical analysis, and it falls with in a group that may cause more than average clams, they assign a nurse to review this information. Based on the nurses discretion (yes, that is actually what their protocol states, and there is no other criteria than their discretion) they will contact the employee to participate (again, participate, is not defined) in on going wellness counseling until the assigned nurse deems that wellness counseling is no longer required (again “no longer” is not defined). If the employee does not "participate" they are levied a $100 per month surcharge until they participate.

    My question:
    After doing lots of research I have ended up here find other opinions since I can not find information from the Department of Labor website or other sources.

    1.Healthcare surcharges, from what I can find, have been for smokers and spouses that can get coverage on other plans. How is this the wellness plan, as described above, legal since it seems arbitrary and based on a persons (nurse) discretion. There is literally no criterion for entry nor exit from the program other than someone opinion.

    2. Since "participate" is not defined how can this wellness program legally levy a surcharge when there is no defined rules for what participating means?

    3. In the interest of preventing discrimination based on health conditions would this program be illegal based on current laws.

    My stance:
    I am not against wellness programs or for what they are trying to accomplish. Since this program has no criterion for entrance or exit other than opinion then I would find it not enforceable and discriminates against employees that have health conditions that the TPA finds undesirable. Since my employer hired the TPA to run this program they find these employees undesirable as well.
     
  2. ElleMD

    ElleMD Well-Known Member

    Messages:
    3,032
    Likes Received:
    496
    Trophy Points:
    83
    1. Totally legal and not at all uncommon.

    2. This is fairly straightforward. I'm not certain what type of clarification is necessary but if you are unsure after being asked to participate, ask the plan.

    3. Not at all.

    You don't have to like it but this is becoming increasingly common among health plans.
     
  3. Betty3

    Betty3 Super Moderator

    Messages:
    6,967
    Likes Received:
    290
    Trophy Points:
    83

    Agree, not illegal. As noted, this is becoming more & more common.
     

Share This Page