Wellness Accounts



Wellness Accounts



Employer-sponsored Wellness Accounts are offered as an incentive to promote employee health and activity-based programs. These accounts are unique to every employer.


Wellness programs can take many forms, and may not even be called a “wellness program.” They may cover only employees or also spouses and other family members. Some wellness programs offer only informational brochures and periodic educational sessions. Others offer education, preventive care, and wellness rewards.


A comprehensive employer-sponsored wellness programs might offer a system of coordinated health-related communications, assessments, and incentives intended to raise health awareness and promote positive health behaviors. Wellness programs might also use one, some, or all of the following tools to promote wellness and decrease health plan costs:


  • health-related newsletters and informative material;

  • lunch-hour sessions on first aid, self-care, or healthy eating;

  • health risk assessments of willing employees;

  • personal consultations with case managers regarding nutrition, lifestyle changes, and related issues;

  • blood pressure and cholesterol screening;

  • optional or compulsory smoking-cessation programs;

  • weight-loss programs;

  • flu shots or other vaccinations;

  • on-site gyms or other exercise facilities;

  • payment of health club dues;

  • diagnostic testing; and

  • financial incentives to encourage participation or achievement of specific wellness standards.

Wellness programs can operate in many ways. Some offer rewards to employees who participate or impose penalties on those who do not. Rewards for participation can take many forms, from cash or cash equivalents (e.g., gift cards or gift certificates), to health benefit plan-related rewards (e.g., reductions or waivers in employee cost-sharing features, such as premiums, co-payments, or deductibles, or additional employer-provided benefits), to other noncash rewards (e.g., employee discounts or merchandise prizes). Penalties for non-participation in a wellness program usually take the form of financial penalties but also can include refusal to hire, disqualification from the employer’s health plan, or termination of employment (note, however, that HIPAA or ADA issues may be raised when a program involves penalties for nonparticipation.


What Is a Disease-Management Program?


An employer-sponsored disease-management program generally identifies employees and their family members who have, or who are at risk for developing, certain chronic medical conditions. A typical disease-management program will identify these individuals and “coach” them on how to manage their conditions. Disease-management programs might provide evidence-based medical information, disease-specific support, case monitoring, and coordination of the care and treatment provided by the employer’s group health plan. A disease-management program might also monitor laboratory or other medical test results; provide telephonic, e-mail, or web-based reminders of treatment or appointment schedules; and furnish information about minimizing health risks. Sometimes, these programs offer rewards (such as reductions or waivers of employee cost-sharing items, such as premiums, co-payments, or deductibles) for employees who participate.


How Are Wellness and Disease-Management Programs Alike (and Different)?


In some ways, employer-sponsored wellness and disease-management programs may appear quite similar—both types of programs are intended to help participants lead healthier lives and lower or control health care costs. In fact, sometimes employers combine wellness and disease-management programs into a single program, or coordinate wellness and disease-management programs with each other or with the employer’s other health plans, such as a major medical plan, health FSA, HRA, or HSA. But wellness and disease-management programs typically differ from one another. Wellness programs generally are designed to help all employees become and stay healthier, while disease-management programs are targeted toward helping only those employees who are at risk for developing, or who have already developed, chronic medical conditions.


Why Would an Employer Offer a Wellness or Disease-Management Program?


Employers offer wellness and disease-management programs in the hope of improving all employees’ general health or helping certain employees manage their chronic medical conditions. Employers typically offer these programs out of a genuine concern for their employees’ well-being and because they believe that such programs can lower employers’ and employees’ health plan costs and even decrease time spent away from work for illness-related absences (i.e., increase “presenteeism”). For example, an employer may believe that an effective wellness or disease-management program might reduce employees’ claims under the employer’s major medical plan, or reduce work-related accidents or disease-related absenteeism. Sometimes, employers that offer insured major medical plans cannot help but offer wellness or disease-management programs to employees because health insurers bundle wellness and disease-management programs along with insured major medical plans. In such cases, the employer has no choice but to offer the wellness or disease-management program alongside its insured major medical plan.


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