Must have a reasonable chance of improving the health of, or preventing disease in, participating enrollees, Must not be overly burdensome, Must not be a subterfuge for discriminating based on a health factor, and Must not be highly suspect in the method chosen to promote health or prevent disease. Determination is based on all the relevant facts and circumstances. Reasonable alternative standard to qualify for the reward must be provided to any individual who does not meet the initial standard based on a measurement, test, or screening that is related to a health factor. 45 CFR The full reward under the outcome-based wellness program must be available to all §146.121(f)(4)(iv) similarly situated individuals. 45 CFR Reward is not available to all similarly situated individuals unless the program allows a §146.121(f)(4)(iv)(A) reasonable alternative standard (or waiver of the otherwise applicable standard) for Wellness Programs obtaining the reward for any individual who does not meet the initial standard based on the health factor measurement. (Cont’d) 45 CFR Reasonable alternative standard must be furnished upon request or the condition for §146.121(f)(4)(iv)(B) obtaining the reward must be waived. 45 CFR Whether issuer has furnished a reasonable alternative standard based on facts “all §146.121(f)(4)(iv)(C) and circumstances”, including but not limited to: 45 CFR §146.121 (f)(4)(iv)(C)(1) If it is completion of an educational program, issuer must make the program available or help the enrollee find one (instead of making them find it unassisted), and may not require enrollee to pay for the program. 45 CFR §146.121 Time commitment required must be reasonable (e.g., a nightly one-hour class (f)(4)(iv)(C)(2) would be unreasonable). If it is a diet program, the issuer is not required to pay for the cost of food but 45 CFR §146.121 (f)(4)(iv)(C)(3)
Wellness Programs (Cont’d) 45 CFR §146.121(f)(4)(iv) 45 CFR §146.121(f)(4)(iv)(A) 45 CFR §146.121(f)(4)(iv)(B) 45 CFR §146.121(f)(4)(iv)(C) 45 CFR §146.121 (f)(4)(iv)(C)(1) 45 CFR §146.121 (f)(4)(iv)(C)(2) 45 CFR §146.121 (f)(4)(iv)(C)(3) Must have a reasonable chance of improving the health of, or preventing disease in, participating enrollees, Must not be overly burdensome, Must not be a subterfuge for discriminating based on a health factor, and Must not be highly suspect in the method chosen to promote health or prevent disease. Determination is based on all the relevant facts and circumstances. Reasonable alternative standard to qualify for the reward must be provided to any individual who does not meet the initial standard based on a measurement, test, or screening that is related to a health factor. The full reward under the outcome-based wellness program must be available to all similarly situated individuals. Reward is not available to all similarly situated individuals unless the program allows a reasonable alternative standard (or waiver of the otherwise applicable standard) for obtaining the reward for any individual who does not meet the initial standard based on the health factor measurement. Reasonable alternative standard must be furnished upon request or the condition for obtaining the reward must be waived. Whether issuer has furnished a reasonable alternative standard based on “all facts and circumstances”, including but not limited to: If it is completion of an educational program, issuer must make the program available or help the enrollee find one (instead of making them find it unassisted), and may not require enrollee to pay for the program. Time commitment required must be reasonable (e.g., a nightly one-hour class would be unreasonable). If it is a diet program, the issuer is not required to pay for the cost of food but